- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $468.75 / $1,850.00 / $3,884.00
| Facility | | $468.75 | $1,850.00 | $3,884.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $2,390.73 / $2,390.73 / $2,390.73
| Facility | 50 | $2,390.73 | $2,390.73 | $2,390.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,607.97 / $3,312.82 / $5,168.50
| Facility | | $1,607.97 | $3,312.82 | $5,168.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,035.90 / $2,035.90 / $2,035.90
| Facility | | $2,035.90 | $2,035.90 | $2,035.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $470.00 / $1,429.00 / $4,010.00
| Facility | | $470.00 | $1,429.00 | $4,010.00 |