- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,175.00 / $4,376.00 / $12,154.00
| Facility | | $1,175.00 | $4,376.00 | $12,154.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $716.07 / $1,269.50 / $9,091.56
| Facility | 50 | $716.07 | $1,269.50 | $9,091.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,461.10 / $5,060.37 / $7,380.07
| Facility | | $1,461.10 | $5,060.37 | $7,380.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,533.00 / $11,533.00 / $11,533.00
| Facility | | $11,533.00 | $11,533.00 | $11,533.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $376.64 / $939.92 / $12,887.09
| Facility | | $376.64 | $939.92 | $12,887.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,779.00 / $3,946.00 / $7,504.00
| Facility | | $1,779.00 | $3,946.00 | $7,504.00 |