- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $691.83 / $4,265.80 / $10,715.19
| Facility | | $691.83 | $4,265.80 | $10,715.19 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $10,715.19 / $10,715.19 / $10,715.19
| Facility | 50 | $10,715.19 | $10,715.19 | $10,715.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,290.87 / $5,248.07 / $11,220.18
| Facility | | $2,290.87 | $5,248.07 | $11,220.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $457.09 / $977.24 / $10,000.00
| Facility | | $457.09 | $977.24 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $4,365.16 / $10,232.93
| Facility | | $1,584.89 | $4,365.16 | $10,232.93 |