- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $977.24 / $3,235.94 / $10,000.00
| Facility | | $977.24 | $3,235.94 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $15,488.17 / $15,488.17 / $19,054.61
| Facility | 50 | $15,488.17 | $15,488.17 | $19,054.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,456.54 / $39,810.72 / $52,480.75
| Facility | | $6,456.54 | $39,810.72 | $52,480.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,071.52 / $3,090.30 / $10,232.93
| Facility | | $1,071.52 | $3,090.30 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $537.03 / $891.25 / $2,951.21
| Professional | | $537.03 | $891.25 | $2,951.21 |
- 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
- $3,630.78 / $19,054.61 / $50,118.72
| Facility | | $3,630.78 | $19,054.61 | $50,118.72 |