- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,011.82 / $4,933.00 / $4,933.00
| Facility | | $1,011.82 | $4,933.00 | $4,933.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,776.11 / $4,432.04 / $6,004.71
| Facility | | $3,776.11 | $4,432.04 | $6,004.71 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $2,546.96 / $2,780.28 / $4,071.35
| Facility | 50 | $2,546.96 | $2,780.28 | $4,071.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $872.87 / $1,011.82 / $4,933.00
| Facility | | $872.87 | $1,011.82 | $4,933.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,356.00 / $11,464.00 / $14,085.00
| Facility | | $5,356.00 | $11,464.00 | $14,085.00 |