- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $837.00 / $2,418.00 / $5,760.95
| Facility | | $837.00 | $2,418.00 | $5,760.95 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $2,090.08 / $5,403.90 / $9,923.89
| Facility | 50 | $2,090.08 | $5,403.90 | $9,923.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,639.60 / $8,069.62 / $11,514.71
| Facility | | $4,639.60 | $8,069.62 | $11,514.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,871.13 / $5,871.13 / $5,871.13
| Facility | | $5,871.13 | $5,871.13 | $5,871.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $882.00 / $3,238.00 / $8,257.00
| Facility | | $882.00 | $3,238.00 | $8,257.00 |