- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $623.00 / $2,303.00 / $6,681.00
| Facility | | $623.00 | $2,303.00 | $6,681.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $371.50 / $1,208.00 / $2,401.00
| Facility | 50 | $371.50 | $1,208.00 | $2,401.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,056.00 / $5,500.00 / $9,272.00
| Facility | | $2,056.00 | $5,500.00 | $9,272.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,254.47 / $15,214.55 / $16,394.00
| Facility | | $4,254.47 | $15,214.55 | $16,394.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,799.00 / $6,073.00 / $13,062.00
| Facility | | $2,799.00 | $6,073.00 | $13,062.00 |