- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,487.78 / $4,933.00 / $4,933.00
| Facility | | $1,487.78 | $4,933.00 | $4,933.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,401.64 / $6,295.80 / $8,529.79
| Facility | | $5,401.64 | $6,295.80 | $8,529.79 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $2,910.20 / $4,264.89 / $5,783.43
| Facility | 50 | $2,910.20 | $4,264.89 | $5,783.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,270.66 / $4,933.00 / $4,933.00
| Facility | | $1,270.66 | $4,933.00 | $4,933.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,906.00 / $4,645.00 / $6,740.00
| Facility | | $1,906.00 | $4,645.00 | $6,740.00 |