- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,700.00 / $8,436.50 / $8,436.50
| Facility | | $1,700.00 | $8,436.50 | $8,436.50 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $1,812.90 / $4,374.76 / $5,087.47
| Facility | 50 | $1,812.90 | $4,374.76 | $5,087.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $191.60 / $213.86 / $233.01
| Facility | | $191.60 | $213.86 | $233.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $204.04 / $204.04 / $204.04
| Facility | | $204.04 | $204.04 | $204.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $930.80 / $1,367.07 / $2,110.48
| Facility | | $930.80 | $1,367.07 | $2,110.48 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $1,677.93 / $3,009.60 / $9,323.28
| Facility | 50 | $1,677.93 | $3,009.60 | $9,323.28 |