- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,046.82 / $4,538.00 / $4,933.00
| Facility | | $1,046.82 | $4,538.00 | $4,933.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,073.82 / $3,582.65 / $4,853.92
| Facility | | $3,073.82 | $3,582.65 | $4,853.92 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $1,656.06 / $2,737.80 / $3,165.18
| Facility | 50 | $1,656.06 | $2,737.80 | $3,165.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $770.94 / $4,538.00 / $4,933.00
| Facility | | $770.94 | $4,538.00 | $4,933.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,500.00 / $7,500.00 / $10,556.00
| Facility | | $2,500.00 | $7,500.00 | $10,556.00 |