- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.08 / $1,842.00 / $7,412.00
| Facility | | $302.08 | $1,842.00 | $7,412.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $881.64 / $3,381.55 / $11,459.64
| Facility | 50 | $881.64 | $3,381.55 | $11,459.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,838.82 / $3,991.07 / $6,264.66
| Facility | | $1,838.82 | $3,991.07 | $6,264.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $709.00 / $12,002.00 / $13,106.00
| Facility | | $709.00 | $12,002.00 | $13,106.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $211.58 / $309.63 / $1,343.21
| Professional | | $211.58 | $309.63 | $1,343.21 |
- 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
- $930.00 / $3,951.00 / $6,625.00
| Facility | | $930.00 | $3,951.00 | $6,625.00 |