- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $455.55 / $1,869.00 / $6,413.90
| Facility | | $455.55 | $1,869.00 | $6,413.90 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $13,686.00 / $13,686.00 / $13,686.00
| Facility | 50 | $13,686.00 | $13,686.00 | $13,686.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,913.49 / $5,398.06 / $7,548.75
| Facility | | $2,913.49 | $5,398.06 | $7,548.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,303.68 / $4,303.68 / $4,303.68
| Facility | | $4,303.68 | $4,303.68 | $4,303.68 |
- 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 |