- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $974.24 / $2,877.00 / $4,933.00
| Facility | | $974.24 | $2,877.00 | $4,933.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,911.81 / $2,243.90 / $3,040.13
| Facility | | $1,911.81 | $2,243.90 | $3,040.13 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $1,031.60 / $1,407.63 / $2,061.29
| Facility | 50 | $1,031.60 | $1,407.63 | $2,061.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $685.13 / $2,877.00 / $4,933.00
| Facility | | $685.13 | $2,877.00 | $4,933.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,423.48 / $5,168.33 / $7,355.00
| Facility | | $1,423.48 | $5,168.33 | $7,355.00 |