- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $244.26 / $3,776.22 / $6,906.00
| Facility | | $244.26 | $3,776.22 | $6,906.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $693.01 / $807.73 / $1,094.33
| Facility | | $693.01 | $807.73 | $1,094.33 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $373.37 / $547.16 / $617.25
| Facility | 50 | $373.37 | $547.16 | $617.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $155.63 / $244.26 / $6,906.00
| Facility | | $155.63 | $244.26 | $6,906.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $300.00 / $1,386.00 / $2,449.00
| Facility | | $300.00 | $1,386.00 | $2,449.00 |