- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $2,754.23 / $6,025.60
| Facility | | $1,000.00 | $2,754.23 | $6,025.60 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $3,090.30 / $3,162.28 / $3,630.78
| Facility | 50 | $3,090.30 | $3,162.28 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $87.10 / $177.83 / $436.52
| Professional | | $87.10 | $177.83 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $141.25 / $436.52 / $5,248.07
| Professional | 50 | $141.25 | $436.52 | $5,248.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.09 / $380.19 / $758.58
| Professional | | $229.09 | $380.19 | $758.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $112.20 / $616.60 / $2,511.89
| Facility | | $112.20 | $616.60 | $2,511.89 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $2,691.53 / $3,235.94 / $4,365.16
| Facility | 50 | $2,691.53 | $3,235.94 | $4,365.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $199.53 / $426.58 / $891.25
| Professional | | $199.53 | $426.58 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $204.17 / $389.05 / $5,248.07
| Professional | 50 | $204.17 | $389.05 | $5,248.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.84 / $524.81 / $977.24
| Professional | | $338.84 | $524.81 | $977.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $251.19 / $794.33
| Facility | | $100.00 | $251.19 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.26 / $181.97 / $426.58
| Professional | | $60.26 | $181.97 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.18 / $436.52 / $870.96
| Professional | | $162.18 | $436.52 | $870.96 |