- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $223.87 / $1,000.00 / $7,413.10
| Facility | | $223.87 | $1,000.00 | $7,413.10 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $891.25 / $6,309.57 / $6,309.57
| Facility | 50 | $891.25 | $6,309.57 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $147.91 / $851.14 / $1,122.02
| Professional | 50 | $147.91 | $851.14 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $134.90 / $165.96 / $363.08
| Professional | 50 | $134.90 | $165.96 | $363.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,549.93 / $10,715.19 / $11,220.18
| Facility | | $9,549.93 | $10,715.19 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $154.88 / $288.40 / $446.68
| Professional | 50 | $154.88 | $288.40 | $446.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $104.71 / $144.54 / $181.97
| Facility | | $104.71 | $144.54 | $181.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.67 / $204.17 / $204.17
| Facility | | $34.67 | $204.17 | $204.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $50.12 / $602.56 / $3,162.28
| Facility | | $50.12 | $602.56 | $3,162.28 |