- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $957.00 / $3,472.77 / $12,600.00
| Facility | | $957.00 | $3,472.77 | $12,600.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $1,842.00 / $4,208.25 / $6,522.00
| Facility | 50 | $1,842.00 | $4,208.25 | $6,522.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,383.45 / $5,337.43 / $8,492.60
| Facility | | $3,383.45 | $5,337.43 | $8,492.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $456.70 / $664.45 / $5,962.62
| Facility | | $456.70 | $664.45 | $5,962.62 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $592.23 / $592.23 / $592.23
| Facility | 50 | $592.23 | $592.23 | $592.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $875.00 / $2,900.00 / $5,543.93
| Facility | | $875.00 | $2,900.00 | $5,543.93 |