- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,110.00 / $3,255.00 / $12,154.00
| Facility | | $1,110.00 | $3,255.00 | $12,154.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $2,506.50 / $2,506.50 / $5,283.00
| Facility | 50 | $2,506.50 | $2,506.50 | $5,283.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $862.00 / $1,818.00 / $4,958.00
| Facility | | $862.00 | $1,818.00 | $4,958.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $92.10 / $92.10 / $92.10
| Facility | | $92.10 | $92.10 | $92.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $72.72 / $119.36 / $875.00
| Facility | | $72.72 | $119.36 | $875.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $245.00 / $875.00 / $1,351.00
| Facility | | $245.00 | $875.00 | $1,351.00 |