- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,367.80 / $4,933.00 / $4,933.00
| Facility | | $1,367.80 | $4,933.00 | $4,933.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,967.47 / $5,789.77 / $7,844.21
| Facility | | $4,967.47 | $5,789.77 | $7,844.21 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $3,117.75 / $4,092.09 / $5,318.59
| Facility | 50 | $3,117.75 | $4,092.09 | $5,318.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,176.90 / $4,933.00 / $4,933.00
| Facility | | $1,176.90 | $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 |