- 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
- $883.87 / $883.87 / $883.87
| Facility | 50 | $883.87 | $883.87 | $883.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,461.10 / $4,152.81 / $5,060.37
| Facility | | $1,461.10 | $4,152.81 | $5,060.37 |
- 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
- $233.62 / $476.71 / $12,887.09
| Facility | | $233.62 | $476.71 | $12,887.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.00 / $3,647.00 / $6,988.00
| Facility | | $1,202.00 | $3,647.00 | $6,988.00 |