- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,095.33 / $3,270.00 / $10,652.88
| Facility | | $1,095.33 | $3,270.00 | $10,652.88 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $0.59 / $6,191.17 / $38,194.24
| Facility | 50 | $0.59 | $6,191.17 | $38,194.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,256.97 / $20,795.18 / $30,127.42
| Facility | | $7,256.97 | $20,795.18 | $30,127.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $996.00 / $11,310.00 / $14,224.00
| Facility | | $996.00 | $11,310.00 | $14,224.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,236.54 / $1,976.25 / $7,541.24
| Professional | | $1,236.54 | $1,976.25 | $7,541.24 |
- 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
- $1,602.00 / $7,500.00 / $14,716.00
| Facility | | $1,602.00 | $7,500.00 | $14,716.00 |