- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $400.00 / $1,850.00 / $4,050.00
| Facility | | $400.00 | $1,850.00 | $4,050.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $298.50 / $932.98 / $3,399.41
| Facility | 50 | $298.50 | $932.98 | $3,399.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,319.73 / $6,033.32 / $11,961.18
| Facility | | $3,319.73 | $6,033.32 | $11,961.18 |
- 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
- $882.00 / $3,238.00 / $8,257.00
| Facility | | $882.00 | $3,238.00 | $8,257.00 |