- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $231.90 / $2,183.83 / $9,062.00
| Facility | | $231.90 | $2,183.83 | $9,062.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $607.32 / $1,774.80 / $4,887.54
| Facility | | $607.32 | $1,774.80 | $4,887.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,221.33 / $1,221.33 / $1,569.43
| Facility | | $1,221.33 | $1,221.33 | $1,569.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $231.90 / $1,041.02 / $1,589.20
| Facility | | $231.90 | $1,041.02 | $1,589.20 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $505.46 / $1,775.91 / $2,383.80
| Facility | 50 | $505.46 | $1,775.91 | $2,383.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $461.00 / $3,866.00 / $6,584.00
| Facility | | $461.00 | $3,866.00 | $6,584.00 |