- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $358.80 / $4,112.00 / $4,933.00
| Facility | | $358.80 | $4,112.00 | $4,933.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,189.82 / $2,556.17 / $3,482.21
| Facility | | $2,189.82 | $2,556.17 | $3,482.21 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $1,188.06 / $1,813.84 / $2,361.03
| Facility | 50 | $1,188.06 | $1,813.84 | $2,361.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $294.14 / $4,112.00 / $4,933.00
| Facility | | $294.14 | $4,112.00 | $4,933.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,524.00 / $5,819.00 / $8,339.00
| Facility | | $2,524.00 | $5,819.00 | $8,339.00 |