- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $724.44 / $3,090.30 / $10,000.00
| Facility | | $724.44 | $3,090.30 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $977.24 / $7,079.46 / $16,218.10
| Facility | 50 | $977.24 | $7,079.46 | $16,218.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,466.84 / $11,748.98 / $15,488.17
| Facility | | $4,466.84 | $11,748.98 | $15,488.17 |
- 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
- $776.25 / $1,258.93 / $4,466.84
| Professional | | $776.25 | $1,258.93 | $4,466.84 |
- 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 |