- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.03 / $2,630.27 / $7,762.47
| Facility | | $537.03 | $2,630.27 | $7,762.47 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $1,513.56 / $4,677.35 / $9,549.93
| Facility | 50 | $1,513.56 | $4,677.35 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.03 / $363.08 / $1,047.13
| Professional | | $123.03 | $363.08 | $1,047.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,548.82 / $4,168.69 / $10,000.00
| Facility | | $1,548.82 | $4,168.69 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.91 / $380.19 / $1,000.00
| Professional | | $147.91 | $380.19 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $213.80 / $1,584.89 / $4,365.16
| Facility | | $213.80 | $1,584.89 | $4,365.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.91 / $416.87 / $1,288.25
| Professional | | $147.91 | $416.87 | $1,288.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $2,884.03 / $6,456.54
| Facility | | $1,023.29 | $2,884.03 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.82 / $295.12 / $1,000.00
| Professional | | $128.82 | $295.12 | $1,000.00 |