- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $667.68 / $2,160.10 / $6,446.00
| Facility | | $667.68 | $2,160.10 | $6,446.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $867.00 / $1,325.36 / $4,950.00
| Facility | 50 | $867.00 | $1,325.36 | $4,950.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,430.00 / $5,467.00 / $9,272.00
| Facility | | $2,430.00 | $5,467.00 | $9,272.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,082.48 / $13,759.35 / $26,542.00
| Facility | | $2,082.48 | $13,759.35 | $26,542.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,259.00 / $4,567.00 / $7,669.00
| Facility | | $2,259.00 | $4,567.00 | $7,669.00 |