- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,175.00 / $4,376.00 / $12,600.00
| Facility | | $1,175.00 | $4,376.00 | $12,600.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $1,446.00 / $1,446.00 / $1,446.00
| Facility | 50 | $1,446.00 | $1,446.00 | $1,446.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,418.39 / $3,452.70 / $5,718.14
| Facility | | $2,418.39 | $3,452.70 | $5,718.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $415.23 / $718.12 / $6,496.00
| Facility | | $415.23 | $718.12 | $6,496.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,436.00 / $3,125.00 / $6,026.00
| Facility | | $1,436.00 | $3,125.00 | $6,026.00 |