- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $240.93 / $2,056.00 / $4,933.00
| Facility | | $240.93 | $2,056.00 | $4,933.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $550.58 / $759.10 / $1,187.16
| Facility | | $550.58 | $759.10 | $1,187.16 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $400.09 / $511.50 / $710.15
| Facility | 50 | $400.09 | $511.50 | $710.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $859.90 / $2,056.00 / $4,933.00
| Facility | | $859.90 | $2,056.00 | $4,933.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $773.00 / $3,005.00 / $4,504.00
| Facility | | $773.00 | $3,005.00 | $4,504.00 |