- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,358.07 / $4,933.00 / $4,933.00
| Facility | | $1,358.07 | $4,933.00 | $4,933.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,772.68 / $5,567.19 / $7,832.63
| Facility | | $4,772.68 | $5,567.19 | $7,832.63 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $2,718.03 / $3,752.51 / $4,893.93
| Facility | 50 | $2,718.03 | $3,752.51 | $4,893.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,159.50 / $4,933.00 / $4,933.00
| Facility | | $1,159.50 | $4,933.00 | $4,933.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,000.00 / $10,192.00 / $14,705.00
| Facility | | $5,000.00 | $10,192.00 | $14,705.00 |