- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,399.27 / $4,933.00 / $6,906.00
| Facility | | $1,399.27 | $4,933.00 | $6,906.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,769.39 / $5,567.33 / $7,584.24
| Facility | | $4,769.39 | $5,567.33 | $7,584.24 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $3,014.42 / $3,511.62 / $5,142.31
| Facility | 50 | $3,014.42 | $3,511.62 | $5,142.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,035.81 / $4,933.00 / $6,906.00
| Facility | | $1,035.81 | $4,933.00 | $6,906.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,069.00 / $8,847.00 / $10,652.00
| Facility | | $4,069.00 | $8,847.00 | $10,652.00 |