- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $940.20 / $2,310.12 / $4,933.00
| Facility | | $940.20 | $2,310.12 | $4,933.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,055.63 / $3,586.41 / $4,859.02
| Facility | | $3,055.63 | $3,586.41 | $4,859.02 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $1,648.81 / $2,429.51 / $3,168.50
| Facility | 50 | $1,648.81 | $2,429.51 | $3,168.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $750.71 / $2,310.12 / $4,933.00
| Facility | | $750.71 | $2,310.12 | $4,933.00 |
- 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 |