- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,988.28 / $4,933.00 / $4,933.00
| Facility | | $2,988.28 | $4,933.00 | $4,933.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,900.48 / $12,724.14 / $17,333.78
| Facility | | $10,900.48 | $12,724.14 | $17,333.78 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $5,881.86 / $9,028.96 / $11,303.14
| Facility | 50 | $5,881.86 | $9,028.96 | $11,303.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,512.94 / $4,933.00 / $4,933.00
| Facility | | $2,512.94 | $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 |