- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $368.49 / $1,972.00 / $9,666.28
| Facility | | $368.49 | $1,972.00 | $9,666.28 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $627.85 / $627.85 / $627.85
| Facility | 50 | $627.85 | $627.85 | $627.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,695.08 / $5,476.63 / $10,326.34
| Facility | | $2,695.08 | $5,476.63 | $10,326.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $709.00 / $709.00 / $735.00
| Facility | | $709.00 | $709.00 | $735.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $391.59 / $617.67 / $1,767.52
| Professional | | $391.59 | $617.67 | $1,767.52 |
- 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 / $3,975.00 / $7,676.23
| Facility | | $930.00 | $3,975.00 | $7,676.23 |