- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $407.38 / $2,398.83 / $7,413.10
| Facility | | $407.38 | $2,398.83 | $7,413.10 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $2,884.03 / $5,248.07 / $7,943.28
| Facility | 50 | $2,884.03 | $5,248.07 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $93.33 / $269.15 / $954.99
| Professional | | $93.33 | $269.15 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $162.18 / $302.00 / $707.95
| Professional | 50 | $162.18 | $302.00 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $77.62 / $85.11 / $104.71
| Professional | | $77.62 | $85.11 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $117.49 / $169.82 / $239.88
| Professional | 50 | $117.49 | $169.82 | $239.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $676.08 / $1,819.70 / $4,168.69
| Facility | | $676.08 | $1,819.70 | $4,168.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.00 / $354.81 / $812.83
| Professional | | $100.00 | $354.81 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $147.91 / $537.03 / $1,230.27
| Professional | 50 | $147.91 | $537.03 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $91.20 / $524.81 / $776.25
| Professional | | $91.20 | $524.81 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.20 / $354.81 / $977.24
| Professional | | $112.20 | $354.81 | $977.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $54.95 / $691.83 / $1,949.84
| Facility | | $54.95 | $691.83 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $549.54 / $870.96 / $4,365.16
| Professional | | $549.54 | $870.96 | $4,365.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $1,380.38 / $2,344.23
| Facility | | $851.14 | $1,380.38 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.82 / $457.09 / $1,000.00
| Professional | | $114.82 | $457.09 | $1,000.00 |