- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,668.79 / $4,933.00 / $4,933.00
| Facility | | $1,668.79 | $4,933.00 | $4,933.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,053.83 / $7,066.65 / $9,626.71
| Facility | | $6,053.83 | $7,066.65 | $9,626.71 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $3,266.63 / $4,457.33 / $6,527.17
| Facility | 50 | $3,266.63 | $4,457.33 | $6,527.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,383.22 / $4,933.00 / $4,933.00
| Facility | | $1,383.22 | $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 |