- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $456.27 / $1,021.00 / $2,010.00
| Facility | | $456.27 | $1,021.00 | $2,010.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $751.50 / $1,823.06 / $4,289.55
| Facility | 50 | $751.50 | $1,823.06 | $4,289.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,700.42 / $8,700.42 / $12,558.97
| Facility | | $8,700.42 | $8,700.42 | $12,558.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,509.58 / $2,509.58 / $2,509.58
| Facility | | $2,509.58 | $2,509.58 | $2,509.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $860.00 / $2,913.00 / $8,411.00
| Facility | | $860.00 | $2,913.00 | $8,411.00 |