- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,207.00 / $4,115.57 / $14,470.63
| Facility | | $1,207.00 | $4,115.57 | $14,470.63 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $8,751.64 / $8,751.64 / $8,751.64
| Facility | 50 | $8,751.64 | $8,751.64 | $8,751.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,538.45 / $12,555.91 / $25,129.37
| Facility | | $8,538.45 | $12,555.91 | $25,129.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $875.00 / $9,319.87 / $12,465.00
| Facility | | $875.00 | $9,319.87 | $12,465.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,207.03 / $1,811.36 / $4,517.30
| Professional | | $1,207.03 | $1,811.36 | $4,517.30 |
- 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
- $2,575.00 / $6,920.00 / $14,716.00
| Facility | | $2,575.00 | $6,920.00 | $14,716.00 |