- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $750.00 / $1,398.00 / $2,825.00
| Facility | | $750.00 | $1,398.00 | $2,825.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $19,405.05 / $19,405.05 / $19,405.05
| Facility | 50 | $19,405.05 | $19,405.05 | $19,405.05 |
- 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 |