- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $614.90 / $4,112.00 / $4,933.00
| Facility | | $614.90 | $4,112.00 | $4,933.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,851.90 / $3,347.30 / $4,535.05
| Facility | | $2,851.90 | $3,347.30 | $4,535.05 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $1,547.27 / $2,267.53 / $3,074.88
| Facility | 50 | $1,547.27 | $2,267.53 | $3,074.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $536.72 / $4,112.00 / $4,933.00
| Facility | | $536.72 | $4,112.00 | $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 |