- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.00 / $2,398.83 / $10,000.00
| Facility | | $302.00 | $2,398.83 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $891.25 / $2,570.40 / $11,481.54
| Facility | 50 | $891.25 | $2,570.40 | $11,481.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,089.30 / $4,786.30 / $6,456.54
| Facility | | $2,089.30 | $4,786.30 | $6,456.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,413.10 / $12,022.64 / $13,182.57
| Facility | | $7,413.10 | $12,022.64 | $13,182.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.98 / $309.03 / $1,348.96
| Professional | | $194.98 | $309.03 | $1,348.96 |
- 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
- $1,288.25 / $3,548.13 / $7,585.78
| Facility | | $1,288.25 | $3,548.13 | $7,585.78 |