- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $853.00 / $2,683.00 / $7,602.00
| Facility | | $853.00 | $2,683.00 | $7,602.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $4,627.50 / $4,627.50 / $4,627.50
| Facility | 50 | $4,627.50 | $4,627.50 | $4,627.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,662.00 / $2,867.00 / $4,235.00
| Facility | | $1,662.00 | $2,867.00 | $4,235.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,195.44 / $5,444.45 / $26,542.00
| Facility | | $1,195.44 | $5,444.45 | $26,542.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,695.00 / $3,616.00 / $6,285.00
| Facility | | $1,695.00 | $3,616.00 | $6,285.00 |