- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $562.34 / $2,570.40 / $9,772.37
| Facility | | $562.34 | $2,570.40 | $9,772.37 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $954.99 / $2,570.40 / $9,549.93
| Facility | 50 | $954.99 | $2,570.40 | $9,549.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,467.37 / $9,120.11 / $12,022.64
| Facility | | $3,467.37 | $9,120.11 | $12,022.64 |
- 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
- $380.19 / $645.65 / $2,884.03
| Professional | | $380.19 | $645.65 | $2,884.03 |
- 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
- $1,698.24 / $5,623.41 / $9,772.37
| Facility | | $1,698.24 | $5,623.41 | $9,772.37 |