- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,712.92 / $4,933.00 / $5,757.00
| Facility | | $1,712.92 | $4,933.00 | $5,757.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,271.83 / $7,361.28 / $9,973.37
| Facility | | $6,271.83 | $7,361.28 | $9,973.37 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $4,230.33 / $4,986.68 / $6,762.21
| Facility | 50 | $4,230.33 | $4,986.68 | $6,762.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,386.27 / $4,933.00 / $5,757.00
| Facility | | $1,386.27 | $4,933.00 | $5,757.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,500.00 / $8,702.00 / $10,652.00
| Facility | | $3,500.00 | $8,702.00 | $10,652.00 |