- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,207.00 / $3,636.00 / $7,125.00
| Facility | | $1,207.00 | $3,636.00 | $7,125.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $7,185.36 / $7,185.36 / $7,185.36
| Facility | 50 | $7,185.36 | $7,185.36 | $7,185.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23,566.45 / $50,409.52 / $100,945.06
| Facility | | $23,566.45 | $50,409.52 | $100,945.06 |
- 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
- $2,923.17 / $4,553.67 / $22,383.68
| Professional | | $2,923.17 | $4,553.67 | $22,383.68 |
- 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 / $5,951.00 / $12,241.00
| Facility | | $1,300.00 | $5,951.00 | $12,241.00 |