- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $107.15 / $1,000.00 / $7,079.46
| Facility | | $107.15 | $1,000.00 | $7,079.46 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $1,862.09 / $1,995.26 / $2,238.72
| Facility | 50 | $1,862.09 | $1,995.26 | $2,238.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.71 / $234.42 / $645.65
| Professional | | $104.71 | $234.42 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $316.23 / $407.38 / $1,023.29
| Professional | 50 | $316.23 | $407.38 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- 53
- Low / Median / High Price
- $51.29 / $51.29 / $97.72
| Professional | 53 | $51.29 | $51.29 | $97.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $524.81 / $524.81 / $524.81
| Facility | | $524.81 | $524.81 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.72 / $199.53 / $398.11
| Professional | | $97.72 | $199.53 | $398.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,621.81 / $2,290.87 / $4,570.88
| Facility | | $1,621.81 | $2,290.87 | $4,570.88 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $1,047.13 / $1,905.46 / $3,630.78
| Facility | 50 | $1,047.13 | $1,905.46 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.15 / $269.15 / $269.15
| Professional | | $269.15 | $269.15 | $269.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $436.52 / $436.52 / $5,011.87
| Facility | | $436.52 | $436.52 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.72 / $208.93 / $426.58
| Professional | | $97.72 | $208.93 | $426.58 |