- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $196.87 / $1,400.00 / $10,790.70
| Facility | | $196.87 | $1,400.00 | $10,790.70 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $5,087.47 / $5,087.47 / $11,248.51
| Facility | 50 | $5,087.47 | $5,087.47 | $11,248.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $212.94 / $237.13 / $258.35
| Facility | | $212.94 | $237.13 | $258.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $228.11 / $228.11 / $228.11
| Facility | | $228.11 | $228.11 | $228.11 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $1,017.12 / $1,017.12 / $2,648.69
| Facility | 50 | $1,017.12 | $1,017.12 | $2,648.69 |