- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $91.43 / $750.00 / $1,831.00
| Facility | | $91.43 | $750.00 | $1,831.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $2,511.00 / $2,511.00 / $2,511.00
| Facility | 50 | $2,511.00 | $2,511.00 | $2,511.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,026.61 / $1,026.61 / $1,026.61
| Facility | | $1,026.61 | $1,026.61 | $1,026.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $993.02 / $993.02 / $2,241.59
| Facility | | $993.02 | $993.02 | $2,241.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $610.00 / $1,530.00 / $4,112.22
| Facility | | $610.00 | $1,530.00 | $4,112.22 |