- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $905.05 / $4,112.00 / $4,933.00
| Facility | | $905.05 | $4,112.00 | $4,933.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,932.51 / $3,441.90 / $4,663.22
| Facility | | $2,932.51 | $3,441.90 | $4,663.22 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $1,582.37 / $2,432.66 / $3,161.79
| Facility | 50 | $1,582.37 | $2,432.66 | $3,161.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $782.02 / $4,112.00 / $4,933.00
| Facility | | $782.02 | $4,112.00 | $4,933.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,450.00 / $5,806.00 / $8,339.00
| Facility | | $1,450.00 | $5,806.00 | $8,339.00 |