- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $465.10 / $3,902.72 / $4,933.00
| Facility | | $465.10 | $3,902.72 | $4,933.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,368.30 / $2,764.51 / $3,766.03
| Facility | | $2,368.30 | $2,764.51 | $3,766.03 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $1,496.84 / $1,883.01 / $2,420.92
| Facility | 50 | $1,496.84 | $1,883.01 | $2,420.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $386.52 / $4,112.00 / $4,933.00
| Facility | | $386.52 | $4,112.00 | $4,933.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,514.14 / $5,806.00 / $9,128.24
| Facility | | $2,514.14 | $5,806.00 | $9,128.24 |