- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $183.21 / $1,021.00 / $1,831.00
| Facility | | $183.21 | $1,021.00 | $1,831.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $750.41 / $750.41 / $1,823.06
| Facility | 50 | $750.41 | $750.41 | $1,823.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,689.47 / $1,689.47 / $1,858.42
| Facility | | $1,689.47 | $1,689.47 | $1,858.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,665.90 / $1,665.90 / $3,495.69
| Facility | | $1,665.90 | $1,665.90 | $3,495.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $700.00 / $2,062.00 / $6,150.00
| Facility | | $700.00 | $2,062.00 | $6,150.00 |