- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,415.00 / $6,870.00 / $13,095.00
| Facility | | $2,415.00 | $6,870.00 | $13,095.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $5,372.25 / $5,372.25 / $5,372.25
| Facility | 50 | $5,372.25 | $5,372.25 | $5,372.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $624.00 / $624.00 / $624.00
| Facility | | $624.00 | $624.00 | $624.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,172.03 / $1,777.50 / $8,000.00
| Facility | | $1,172.03 | $1,777.50 | $8,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,729.00 / $8,000.00 / $17,483.00
| Facility | | $2,729.00 | $8,000.00 | $17,483.00 |