- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $634.00 / $1,140.00 / $2,010.00
| Facility | | $634.00 | $1,140.00 | $2,010.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $6,073.25 / $6,073.25 / $12,146.50
| Facility | 50 | $6,073.25 | $6,073.25 | $12,146.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,088.02 / $1,088.02 / $1,088.02
| Facility | | $1,088.02 | $1,088.02 | $1,088.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,061.42 / $1,173.42 / $2,668.68
| Facility | | $1,061.42 | $1,173.42 | $2,668.68 |
- 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 |