- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $819.57 / $4,617.00 / $6,620.78
| Facility | | $819.57 | $4,617.00 | $6,620.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,790.03 / $5,603.57 / $7,511.42
| Facility | | $3,790.03 | $5,603.57 | $7,511.42 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $2,639.46 / $4,035.78 / $5,037.17
| Facility | 50 | $2,639.46 | $4,035.78 | $5,037.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $655.41 / $4,617.00 / $5,976.27
| Facility | | $655.41 | $4,617.00 | $5,976.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,572.52 / $7,500.00 / $9,340.21
| Facility | | $2,572.52 | $7,500.00 | $9,340.21 |