- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $790.80 / $2,409.00 / $10,159.50
| Facility | | $790.80 | $2,409.00 | $10,159.50 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $1,328.60 / $5,079.75 / $10,435.00
| Facility | 50 | $1,328.60 | $5,079.75 | $10,435.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,310.72 / $9,020.15 / $12,628.21
| Facility | | $3,310.72 | $9,020.15 | $12,628.21 |
- 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
- $504.46 / $802.55 / $2,868.68
| Professional | | $504.46 | $802.55 | $2,868.68 |
- 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
- $1,152.00 / $4,803.00 / $8,995.00
| Facility | | $1,152.00 | $4,803.00 | $8,995.00 |