- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,162.00 / $2,640.00 / $6,060.00
| Facility | | $1,162.00 | $2,640.00 | $6,060.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $7,605.00 / $7,605.00 / $7,605.00
| Facility | 50 | $7,605.00 | $7,605.00 | $7,605.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $86.13 / $316.80 / $518.16
| Facility | | $86.13 | $316.80 | $518.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $168.29 / $785.89 / $1,661.72
| Facility | | $168.29 | $785.89 | $1,661.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $704.00 / $1,535.00 / $2,175.00
| Facility | | $704.00 | $1,535.00 | $2,175.00 |