- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $734.70 / $3,316.70 / $8,682.65
| Facility | | $734.70 | $3,316.70 | $8,682.65 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $2,911.79 / $6,604.58 / $12,190.47
| Facility | 50 | $2,911.79 | $6,604.58 | $12,190.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,760.00 / $9,256.00 / $17,400.00
| Facility | | $4,760.00 | $9,256.00 | $17,400.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $800.11 / $1,406.90 / $3,153.80
| Facility | | $800.11 | $1,406.90 | $3,153.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,912.00 / $6,434.50 / $12,703.00
| Facility | | $2,912.00 | $6,434.50 | $12,703.00 |