- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,298.25 / $5,364.57 / $10,808.00
| Facility | | $1,298.25 | $5,364.57 | $10,808.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $6,576.00 / $6,576.00 / $6,576.00
| Facility | 50 | $6,576.00 | $6,576.00 | $6,576.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,597.30 / $4,990.03 / $6,069.38
| Facility | | $2,597.30 | $4,990.03 | $6,069.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $624.00 / $10,969.00 / $10,969.00
| Facility | | $624.00 | $10,969.00 | $10,969.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $752.73 / $1,176.58 / $12,989.00
| Facility | | $752.73 | $1,176.58 | $12,989.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,269.00 / $6,407.00 / $12,989.00
| Facility | | $2,269.00 | $6,407.00 | $12,989.00 |