- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $860.00 / $2,726.00 / $5,260.00
| Facility | | $860.00 | $2,726.00 | $5,260.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $4,000.00 / $4,000.00 / $4,000.00
| Facility | 50 | $4,000.00 | $4,000.00 | $4,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,055.03 / $7,756.95 / $11,542.68
| Facility | | $5,055.03 | $7,756.95 | $11,542.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.00 / $40.00 / $40.00
| Facility | | $40.00 | $40.00 | $40.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,149.00 / $3,533.00 / $10,655.00
| Facility | | $1,149.00 | $3,533.00 | $10,655.00 |