- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $989.05 / $4,933.00 / $4,933.00
| Facility | | $989.05 | $4,933.00 | $4,933.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,803.76 / $4,440.14 / $6,048.69
| Facility | | $3,803.76 | $4,440.14 | $6,048.69 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $2,404.10 / $3,110.63 / $4,101.17
| Facility | 50 | $2,404.10 | $3,110.63 | $4,101.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $816.47 / $4,933.00 / $4,933.00
| Facility | | $816.47 | $4,933.00 | $4,933.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,906.00 / $4,645.00 / $6,327.00
| Facility | | $1,906.00 | $4,645.00 | $6,327.00 |