- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $263.03 / $2,238.72 / $7,943.28
| Facility | | $263.03 | $2,238.72 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $89.13 / $436.52 / $2,290.87
| Professional | | $89.13 | $436.52 | $2,290.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,621.81 / $3,981.07 / $10,715.19
| Facility | | $1,621.81 | $3,981.07 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.72 / $1,122.02 / $2,818.38
| Professional | | $97.72 | $1,122.02 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $141.25 / $1,659.59 / $3,548.13
| Professional | 50 | $141.25 | $1,659.59 | $3,548.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.67 / $2,041.74 / $7,079.46
| Facility | | $34.67 | $2,041.74 | $7,079.46 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $93.33 / $93.33 / $93.33
| Facility | 62 | $93.33 | $93.33 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.00 / $407.38 / $2,454.71
| Professional | | $100.00 | $407.38 | $2,454.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $263.03 / $1,202.26 / $3,630.78
| Facility | | $263.03 | $1,202.26 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $91.20 / $891.25 / $2,238.72
| Professional | | $91.20 | $891.25 | $2,238.72 |