- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $391.39 / $1,230.00 / $3,685.00
| Facility | | $391.39 | $1,230.00 | $3,685.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $1,617.50 / $1,617.50 / $1,617.50
| Facility | 50 | $1,617.50 | $1,617.50 | $1,617.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,297.79 / $4,340.72 / $6,168.35
| Facility | | $2,297.79 | $4,340.72 | $6,168.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,973.34 / $1,973.34 / $1,973.34
| Facility | | $1,973.34 | $1,973.34 | $1,973.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $746.00 / $2,415.00 / $6,585.00
| Facility | | $746.00 | $2,415.00 | $6,585.00 |