- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,170.00 / $2,640.00 / $5,506.00
| Facility | | $1,170.00 | $2,640.00 | $5,506.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $632.91 / $632.91 / $632.91
| Facility | 50 | $632.91 | $632.91 | $632.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $105.58 / $397.47 / $650.12
| Facility | | $105.58 | $397.47 | $650.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $78.16 / $210.95 / $1,438.00
| Facility | | $78.16 | $210.95 | $1,438.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,086.00 / $1,958.00 / $3,268.00
| Facility | | $1,086.00 | $1,958.00 | $3,268.00 |