- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $859.18 / $2,553.56 / $7,960.13
| Facility | | $859.18 | $2,553.56 | $7,960.13 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $1,875.01 / $3,515.86 / $8,800.97
| Facility | 50 | $1,875.01 | $3,515.86 | $8,800.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,248.00 / $9,198.00 / $17,487.00
| Facility | | $4,248.00 | $9,198.00 | $17,487.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,825.44 / $3,704.28 / $4,777.05
| Facility | | $2,825.44 | $3,704.28 | $4,777.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,206.00 / $6,578.00 / $13,355.00
| Facility | | $3,206.00 | $6,578.00 | $13,355.00 |