- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $200.05 / $2,056.00 / $4,933.00
| Facility | | $200.05 | $2,056.00 | $4,933.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,705.94 / $4,319.39 / $5,852.10
| Facility | | $3,705.94 | $4,319.39 | $5,852.10 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $2,119.41 / $2,709.62 / $3,967.88
| Facility | 50 | $2,119.41 | $2,709.62 | $3,967.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $839.30 / $2,056.00 / $4,933.00
| Facility | | $839.30 | $2,056.00 | $4,933.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $464.00 / $1,418.00 / $2,449.00
| Facility | | $464.00 | $1,418.00 | $2,449.00 |