- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $338.00 / $1,300.00 / $5,547.56
| Facility | | $338.00 | $1,300.00 | $5,547.56 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $2,090.11 / $4,357.74 / $9,348.96
| Facility | 50 | $2,090.11 | $4,357.74 | $9,348.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,946.59 / $4,401.32 / $6,182.30
| Facility | | $1,946.59 | $4,401.32 | $6,182.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $40.00 / $40.00 / $40.00
| Facility | | $40.00 | $40.00 | $40.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $194.00 / $513.00 / $1,226.00
| Facility | | $194.00 | $513.00 | $1,226.00 |