- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $800.00 / $1,399.00 / $2,250.00
| Facility | | $800.00 | $1,399.00 | $2,250.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,210.97 / $7,518.88 / $10,115.29
| Facility | | $6,210.97 | $7,518.88 | $10,115.29 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $9,316.45 / $11,278.31 / $15,172.94
| Facility | 50 | $9,316.45 | $11,278.31 | $15,172.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,800.00 / $3,800.00 / $11,745.00
| Facility | | $3,800.00 | $3,800.00 | $11,745.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,125.00 / $6,079.00 / $9,624.00
| Facility | | $2,125.00 | $6,079.00 | $9,624.00 |