- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $587.00 / $1,842.00 / $5,844.74
| Facility | | $587.00 | $1,842.00 | $5,844.74 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $969.82 / $2,570.00 / $8,339.52
| Facility | 50 | $969.82 | $2,570.00 | $8,339.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,310.72 / $8,274.00 / $11,762.27
| Facility | | $3,310.72 | $8,274.00 | $11,762.27 |
- 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
- $404.17 / $661.37 / $2,672.27
| Professional | | $404.17 | $661.37 | $2,672.27 |
- 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 / $5,000.00 / $8,995.00
| Facility | | $1,152.00 | $5,000.00 | $8,995.00 |