- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $493.62 / $2,498.00 / $5,203.00
| Facility | | $493.62 | $2,498.00 | $5,203.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $10,062.92 / $10,062.92 / $10,062.92
| Facility | 50 | $10,062.92 | $10,062.92 | $10,062.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,767.04 / $3,766.39 / $6,792.29
| Facility | | $1,767.04 | $3,766.39 | $6,792.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,669.55 / $1,669.55 / $1,669.55
| Facility | | $1,669.55 | $1,669.55 | $1,669.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $746.00 / $2,415.00 / $6,585.00
| Facility | | $746.00 | $2,415.00 | $6,585.00 |