- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,700.00 / $5,458.00 / $12,379.71
| Facility | | $1,700.00 | $5,458.00 | $12,379.71 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $4,731.00 / $4,731.00 / $4,731.00
| Facility | 50 | $4,731.00 | $4,731.00 | $4,731.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,025.40 / $4,374.46 / $6,134.20
| Facility | | $2,025.40 | $4,374.46 | $6,134.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,696.00 / $10,696.00 / $10,696.00
| Facility | | $10,696.00 | $10,696.00 | $10,696.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $441.50 / $799.35 / $12,199.00
| Facility | | $441.50 | $799.35 | $12,199.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,967.00 / $4,960.00 / $11,732.00
| Facility | | $1,967.00 | $4,960.00 | $11,732.00 |