- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $239.88 / $2,691.53 / $8,511.38
| Facility | | $239.88 | $2,691.53 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $977.24 / $2,089.30 / $2,290.87
| Facility | 50 | $977.24 | $2,089.30 | $2,290.87 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $389.05 / $389.05 / $389.05
| Facility | 52 | $389.05 | $389.05 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $77.62 / $194.98 / $407.38
| Professional | | $77.62 | $194.98 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $120.23 / $380.19 / $630.96
| Professional | 50 | $120.23 | $380.19 | $630.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $3,715.35 / $9,549.93
| Facility | | $1,513.56 | $3,715.35 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $69.18 / $128.82 / $323.59
| Professional | | $69.18 | $128.82 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $100.00 / $186.21 / $398.11
| Professional | 50 | $100.00 | $186.21 | $398.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $141.25 / $660.69 / $1,659.59
| Facility | | $141.25 | $660.69 | $1,659.59 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $112.20 / $112.20 / $112.20
| Facility | 52 | $112.20 | $112.20 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $91.20 / $218.78 / $512.86
| Professional | | $91.20 | $218.78 | $512.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $562.34 / $1,949.84 / $4,677.35
| Facility | | $562.34 | $1,949.84 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.86 / $181.97 / $380.19
| Professional | | $75.86 | $181.97 | $380.19 |