- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,543.73 / $4,933.00 / $4,933.00
| Facility | | $1,543.73 | $4,933.00 | $4,933.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,746.35 / $6,707.73 / $9,137.77
| Facility | | $5,746.35 | $6,707.73 | $9,137.77 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $3,117.63 / $5,154.05 / $6,195.65
| Facility | 50 | $3,117.63 | $5,154.05 | $6,195.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,219.47 / $4,933.00 / $4,933.00
| Facility | | $1,219.47 | $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 |