- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $769.86 / $2,460.00 / $9,477.00
| Facility | | $769.86 | $2,460.00 | $9,477.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $2,122.55 / $2,122.55 / $2,122.55
| Facility | 50 | $2,122.55 | $2,122.55 | $2,122.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,955.73 / $8,955.73 / $10,746.88
| Facility | | $8,955.73 | $8,955.73 | $10,746.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,875.75 / $5,875.75 / $5,875.75
| Facility | | $5,875.75 | $5,875.75 | $5,875.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,000.00 / $4,334.00 / $8,676.00
| Facility | | $2,000.00 | $4,334.00 | $8,676.00 |