- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $763.72 / $1,831.00 / $3,466.50
| Facility | | $763.72 | $1,831.00 | $3,466.50 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $3,881.20 / $4,906.34 / $10,673.30
| Facility | 50 | $3,881.20 | $4,906.34 | $10,673.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,851.25 / $2,851.25 / $2,851.25
| Facility | | $2,851.25 | $2,851.25 | $2,851.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,775.00 / $2,775.00 / $5,238.99
| Facility | | $2,775.00 | $2,775.00 | $5,238.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $860.00 / $2,717.00 / $7,175.00
| Facility | | $860.00 | $2,717.00 | $7,175.00 |