- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $804.75 / $4,451.43 / $11,373.60
| Facility | | $804.75 | $4,451.43 | $11,373.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,866.43 / $8,059.17 / $10,918.89
| Facility | | $6,866.43 | $8,059.17 | $10,918.89 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $3,954.41 / $5,696.06 / $7,403.30
| Facility | 50 | $3,954.41 | $5,696.06 | $7,403.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $588.99 / $4,933.00 / $11,373.60
| Facility | | $588.99 | $4,933.00 | $11,373.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,500.00 / $7,780.00 / $9,202.00
| Facility | | $2,500.00 | $7,780.00 | $9,202.00 |