- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $4,466.84 / $9,332.54
| Facility | | $1,023.29 | $4,466.84 | $9,332.54 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $3,388.44 / $3,388.44 / $14,791.08
| Facility | 50 | $3,388.44 | $3,388.44 | $14,791.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,897.79 / $5,888.44 / $14,125.38
| Facility | | $4,897.79 | $5,888.44 | $14,125.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $537.03 / $1,000.00 / $3,801.89
| Professional | | $537.03 | $1,000.00 | $3,801.89 |
- 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
- $1,584.89 / $4,365.16 / $9,332.54
| Facility | | $1,584.89 | $4,365.16 | $9,332.54 |