- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $687.37 / $1,140.00 / $1,980.00
| Facility | | $687.37 | $1,140.00 | $1,980.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $2,970.00 / $2,970.00 / $2,970.00
| Facility | 50 | $2,970.00 | $2,970.00 | $2,970.00 |
- 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 / $3,151.25
| Facility | | $1,712.45 | $1,712.45 | $3,151.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $700.00 / $2,062.00 / $6,150.00
| Facility | | $700.00 | $2,062.00 | $6,150.00 |