- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $165.56 / $2,484.50 / $7,582.07
| Facility | | $165.56 | $2,484.50 | $7,582.07 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $2,506.50 / $2,506.50 / $5,283.00
| Facility | 50 | $2,506.50 | $2,506.50 | $5,283.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $862.00 / $1,183.00 / $3,136.06
| Facility | | $862.00 | $1,183.00 | $3,136.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $92.10 / $92.10 / $92.10
| Facility | | $92.10 | $92.10 | $92.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $367.00 / $1,189.50 / $2,726.50
| Facility | | $367.00 | $1,189.50 | $2,726.50 |