- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $93.31 / $4,375.00 / $9,870.00
| Facility | | $93.31 | $4,375.00 | $9,870.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $375.00 / $375.00 / $375.00
| Facility | | $375.00 | $375.00 | $375.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $88.39 / $165.70 / $993.85
| Facility | | $88.39 | $165.70 | $993.85 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $155.30 / $337.67 / $2,203.50
| Facility | 50 | $155.30 | $337.67 | $2,203.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $358.00 / $1,221.00 / $3,585.00
| Facility | | $358.00 | $1,221.00 | $3,585.00 |