- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,082.57 / $4,933.00 / $6,906.00
| Facility | | $1,082.57 | $4,933.00 | $6,906.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,933.68 / $4,584.84 / $6,211.73
| Facility | | $3,933.68 | $4,584.84 | $6,211.73 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $2,107.83 / $3,235.62 / $4,211.72
| Facility | 50 | $2,107.83 | $3,235.62 | $4,211.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $926.51 / $4,933.00 / $4,933.00
| Facility | | $926.51 | $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 |