- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,148.15 / $5,128.61 / $15,135.61
| Facility | | $1,148.15 | $5,128.61 | $15,135.61 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $5,495.41 / $13,489.63 / $30,199.52
| Facility | 50 | $5,495.41 | $13,489.63 | $30,199.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,466.84 / $11,220.18 / $14,125.38
| Facility | | $4,466.84 | $11,220.18 | $14,125.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,370.32 / $11,220.18 / $14,125.38
| Facility | | $5,370.32 | $11,220.18 | $14,125.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $630.96 / $1,000.00 / $3,548.13
| Professional | | $630.96 | $1,000.00 | $3,548.13 |
- 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
- $2,570.40 / $7,943.28 / $16,982.44
| Facility | | $2,570.40 | $7,943.28 | $16,982.44 |