- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,700.00 / $6,467.03 / $12,154.00
| Facility | | $1,700.00 | $6,467.03 | $12,154.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $4,249.50 / $4,249.50 / $4,249.50
| Facility | 50 | $4,249.50 | $4,249.50 | $4,249.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,597.30 / $5,765.91 / $6,526.32
| Facility | | $2,597.30 | $5,765.91 | $6,526.32 |
- 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
- $1,066.71 / $1,667.13 / $12,989.00
| Facility | | $1,066.71 | $1,667.13 | $12,989.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,269.00 / $6,724.00 / $12,989.00
| Facility | | $2,269.00 | $6,724.00 | $12,989.00 |