- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,296.97 / $4,933.00 / $5,757.00
| Facility | | $1,296.97 | $4,933.00 | $5,757.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,713.51 / $5,493.76 / $7,443.18
| Facility | | $4,713.51 | $5,493.76 | $7,443.18 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $2,525.69 / $3,446.31 / $4,853.60
| Facility | 50 | $2,525.69 | $3,446.31 | $4,853.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,108.47 / $4,933.00 / $5,757.00
| Facility | | $1,108.47 | $4,933.00 | $5,757.00 |
- 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 |