- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $290.95 / $2,682.00 / $5,890.30
| Facility | | $290.95 | $2,682.00 | $5,890.30 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $2,688.30 / $3,052.35 / $4,565.56
| Facility | 50 | $2,688.30 | $3,052.35 | $4,565.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,723.00 / $3,693.00 / $5,962.00
| Facility | | $1,723.00 | $3,693.00 | $5,962.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $405.50 / $550.00 / $1,009.20
| Facility | | $405.50 | $550.00 | $1,009.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,216.00 / $2,600.00 / $5,490.00
| Facility | | $1,216.00 | $2,600.00 | $5,490.00 |