- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $91.20 / $1,122.02 / $8,912.51
| Facility | | $91.20 | $1,122.02 | $8,912.51 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $3,801.89 / $3,801.89 / $3,801.89
| Facility | 50 | $3,801.89 | $3,801.89 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $61.66 / $100.00 / $218.78
| Professional | | $61.66 | $100.00 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $162.18 / $331.13 / $562.34
| Professional | 50 | $162.18 | $331.13 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.12 / $58.88 / $104.71
| Professional | | $50.12 | $58.88 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51.29 / $117.49 / $162.18
| Professional | | $51.29 | $117.49 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $75.86 / $173.78 / $245.47
| Professional | 50 | $75.86 | $173.78 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $77.62 / $134.90 / $245.47
| Professional | | $77.62 | $134.90 | $245.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,413.10 / $7,413.10 / $7,413.10
| Facility | | $7,413.10 | $7,413.10 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $63.10 / $120.23 / $234.42
| Professional | | $63.10 | $120.23 | $234.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,413.10 / $7,413.10 / $7,413.10
| Facility | | $7,413.10 | $7,413.10 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $66.07 / $123.03 / $223.87
| Professional | | $66.07 | $123.03 | $223.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $74.13 / $74.13 / $117.49
| Facility | | $74.13 | $74.13 | $117.49 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $109.65 / $109.65 / $109.65
| Facility | 50 | $109.65 | $109.65 | $109.65 |