- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $350.54 / $953.35 / $2,812.00
| Facility | | $350.54 | $953.35 | $2,812.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $916.00 / $916.00 / $916.00
| Facility | 50 | $916.00 | $916.00 | $916.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,627.26 / $2,627.26 / $3,152.71
| Facility | | $2,627.26 | $2,627.26 | $3,152.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,360.08 / $2,360.08 / $2,360.08
| Facility | | $2,360.08 | $2,360.08 | $2,360.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $980.00 / $1,749.90 / $4,064.00
| Facility | | $980.00 | $1,749.90 | $4,064.00 |