- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,183.50 / $3,811.00 / $21,906.70
| Facility | | $1,183.50 | $3,811.00 | $21,906.70 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $943.53 / $6,614.00 / $15,795.25
| Facility | 50 | $943.53 | $6,614.00 | $15,795.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,209.52 / $10,586.19 / $19,960.54
| Facility | | $5,209.52 | $10,586.19 | $19,960.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $875.00 / $11,310.00 / $14,224.00
| Facility | | $875.00 | $11,310.00 | $14,224.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,052.70 / $1,674.75 / $4,425.18
| Professional | | $1,052.70 | $1,674.75 | $4,425.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $100.00 / $100.00
| Facility | | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,152.00 / $5,000.00 / $8,995.00
| Facility | | $1,152.00 | $5,000.00 | $8,995.00 |