- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,573.00 / $3,606.00 / $9,872.00
| Facility | | $1,573.00 | $3,606.00 | $9,872.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $10,072.50 / $10,072.50 / $10,072.50
| Facility | 50 | $10,072.50 | $10,072.50 | $10,072.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,946.00 / $9,472.00 / $17,487.00
| Facility | | $5,946.00 | $9,472.00 | $17,487.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $392.79 / $561.69 / $670.95
| Facility | | $392.79 | $561.69 | $670.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $472.10 / $581.63 / $747.81
| Professional | | $472.10 | $581.63 | $747.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,128.00 / $11,924.00 / $19,737.00
| Facility | | $7,128.00 | $11,924.00 | $19,737.00 |