- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $762.00 / $1,850.00 / $4,050.00
| Facility | | $762.00 | $1,850.00 | $4,050.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $2,383.92 / $7,785.40 / $16,507.06
| Facility | 50 | $2,383.92 | $7,785.40 | $16,507.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,908.30 / $3,920.13 / $6,258.73
| Facility | | $1,908.30 | $3,920.13 | $6,258.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,803.25 / $1,803.25 / $1,803.25
| Facility | | $1,803.25 | $1,803.25 | $1,803.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $689.00 / $689.00 / $689.00
| Facility | | $689.00 | $689.00 | $689.00 |
- 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 |