- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $91.43 / $1,616.00 / $6,681.00
| Facility | | $91.43 | $1,616.00 | $6,681.00 |
- 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
- $1,565.00 / $2,800.00 / $3,681.00
| Facility | | $1,565.00 | $2,800.00 | $3,681.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $871.33 / $871.33
| Facility | | $55.00 | $871.33 | $871.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,128.00 / $2,297.00 / $4,326.00
| Facility | | $1,128.00 | $2,297.00 | $4,326.00 |