- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,122.02 / $3,388.44 / $4,897.79
| Facility | | $1,122.02 | $3,388.44 | $4,897.79 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $1,202.26 / $1,202.26 / $1,202.26
| Facility | 50 | $1,202.26 | $1,202.26 | $1,202.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.91 / $1,000.00 / $2,187.76
| Professional | | $147.91 | $1,000.00 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $9,120.11 / $9,120.11 / $9,549.93
| Professional | 50 | $9,120.11 | $9,120.11 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.78 / $831.76 / $1,659.59
| Professional | | $173.78 | $831.76 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $33.11 / $4,466.84
| Professional | | $32.36 | $33.11 | $4,466.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $2,884.03 / $6,760.83
| Facility | | $2,454.71 | $2,884.03 | $6,760.83 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $3,715.35 / $4,365.16 / $10,232.93
| Facility | 50 | $3,715.35 | $4,365.16 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.80 / $323.59 / $1,778.28
| Professional | | $213.80 | $323.59 | $1,778.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.49 / $851.14 / $2,344.23
| Professional | | $158.49 | $851.14 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.55 / $1,174.90 / $1,905.46
| Professional | | $190.55 | $1,174.90 | $1,905.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $4,466.84 / $5,128.61
| Facility | | $1,698.24 | $4,466.84 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.54 / $831.76 / $1,737.80
| Professional | | $144.54 | $831.76 | $1,737.80 |