- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $682.82 / $1,842.00 / $7,346.75
| Facility | | $682.82 | $1,842.00 | $7,346.75 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $807.25 / $5,060.16 / $10,188.78
| Facility | 50 | $807.25 | $5,060.16 | $10,188.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,310.72 / $8,681.84 / $12,586.46
| Facility | | $3,310.72 | $8,681.84 | $12,586.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $875.00 / $12,002.00 / $13,106.00
| Facility | | $875.00 | $12,002.00 | $13,106.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $476.15 / $757.30 / $2,762.30
| Professional | | $476.15 | $757.30 | $2,762.30 |
- 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
- $1,152.00 / $4,803.00 / $8,995.00
| Facility | | $1,152.00 | $4,803.00 | $8,995.00 |