- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $126.50 / $997.35 / $2,812.00
| Facility | | $126.50 | $997.35 | $2,812.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $2,511.00 / $2,511.00 / $2,511.00
| Facility | 50 | $2,511.00 | $2,511.00 | $2,511.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,886.47 / $1,886.47 / $2,263.76
| Facility | | $1,886.47 | $1,886.47 | $2,263.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,544.97 / $1,544.97 / $1,544.97
| Facility | | $1,544.97 | $1,544.97 | $1,544.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $590.00 / $1,431.00 / $5,241.00
| Facility | | $590.00 | $1,431.00 | $5,241.00 |