- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $601.00 / $1,021.04 / $2,825.00
| Facility | | $601.00 | $1,021.04 | $2,825.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $9,275.87 / $9,275.87 / $9,275.87
| Facility | 50 | $9,275.87 | $9,275.87 | $9,275.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,790.06 / $1,790.06 / $1,790.06
| Facility | | $1,790.06 | $1,790.06 | $1,790.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,712.45 / $1,712.45 / $1,712.45
| Facility | | $1,712.45 | $1,712.45 | $1,712.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $700.00 / $2,148.00 / $6,612.00
| Facility | | $700.00 | $2,148.00 | $6,612.00 |