- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $202.96 / $2,530.01 / $4,254.14
| Facility | | $202.96 | $2,530.01 | $4,254.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,301.60 / $2,701.40 / $3,659.97
| Facility | | $2,301.60 | $2,701.40 | $3,659.97 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $1,241.94 / $1,829.99 / $2,481.55
| Facility | 50 | $1,241.94 | $1,829.99 | $2,481.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $184.00 / $2,192.11 / $4,933.00
| Facility | | $184.00 | $2,192.11 | $4,933.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,050.00 / $3,640.00 / $6,327.00
| Facility | | $1,050.00 | $3,640.00 | $6,327.00 |