- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $93.15 / $684.16 / $3,139.00
| Facility | | $93.15 | $684.16 | $3,139.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $402.70 / $668.31 / $1,910.14
| Facility | 50 | $402.70 | $668.31 | $1,910.14 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $22.92 / $32.88 / $50.70
| Facility | 52 | $22.92 | $32.88 | $50.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43.18 / $70.39 / $183.49
| Professional | | $43.18 | $70.39 | $183.49 |
- Facility/Professional
- Professional
- Modifier
- 22
- Low / Median / High Price
- $283.56 / $637.50 / $956.25
| Professional | 22 | $283.56 | $637.50 | $956.25 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $75.06 / $126.84 / $361.25
| Professional | 50 | $75.06 | $126.84 | $361.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,223.09 / $2,479.00 / $4,441.52
| Facility | | $1,223.09 | $2,479.00 | $4,441.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51.55 / $75.55 / $123.31
| Professional | | $51.55 | $75.55 | $123.31 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $72.46 / $101.30 / $169.64
| Professional | 50 | $72.46 | $101.30 | $169.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $71.51 / $77.04 / $330.00
| Facility | | $71.51 | $77.04 | $330.00 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $61.63 / $61.63 / $61.63
| Facility | 52 | $61.63 | $61.63 | $61.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $53.66 / $81.45 / $130.95
| Professional | | $53.66 | $81.45 | $130.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $293.00 / $1,181.00 / $3,016.00
| Facility | | $293.00 | $1,181.00 | $3,016.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $58.41 / $83.04 / $138.38
| Professional | | $58.41 | $83.04 | $138.38 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $80.00 / $80.00 / $85.00
| Professional | 50 | $80.00 | $80.00 | $85.00 |