- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $927.56 / $4,112.00 / $4,933.00
| Facility | | $927.56 | $4,112.00 | $4,933.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,132.42 / $2,485.42 / $3,367.36
| Facility | | $2,132.42 | $2,485.42 | $3,367.36 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $1,338.38 / $1,683.68 / $2,195.81
| Facility | 50 | $1,338.38 | $1,683.68 | $2,195.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $758.90 / $4,112.00 / $4,933.00
| Facility | | $758.90 | $4,112.00 | $4,933.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,450.00 / $4,985.00 / $8,339.00
| Facility | | $1,450.00 | $4,985.00 | $8,339.00 |