- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $763.24 / $4,933.00 / $4,933.00
| Facility | | $763.24 | $4,933.00 | $4,933.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,915.85 / $3,403.68 / $4,636.75
| Facility | | $2,915.85 | $3,403.68 | $4,636.75 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $1,966.73 / $2,318.38 / $3,143.84
| Facility | 50 | $1,966.73 | $2,318.38 | $3,143.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $612.25 / $4,933.00 / $4,933.00
| Facility | | $612.25 | $4,933.00 | $4,933.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,296.00 / $7,849.00 / $9,202.00
| Facility | | $3,296.00 | $7,849.00 | $9,202.00 |