- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $722.51 / $1,892.00 / $5,430.00
| Facility | | $722.51 | $1,892.00 | $5,430.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $1,100.00 / $3,678.05 / $14,244.00
| Facility | 50 | $1,100.00 | $3,678.05 | $14,244.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,006.73 / $9,177.43 / $15,352.01
| Facility | | $4,006.73 | $9,177.43 | $15,352.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $620.00 / $11,310.00 / $14,224.00
| Facility | | $620.00 | $11,310.00 | $14,224.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $593.66 / $1,224.45 / $5,734.14
| Professional | | $593.66 | $1,224.45 | $5,734.14 |
- 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
- $1,300.00 / $5,978.00 / $12,241.00
| Facility | | $1,300.00 | $5,978.00 | $12,241.00 |