- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $562.34 / $2,951.21 / $8,912.51
| Facility | | $562.34 | $2,951.21 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $54.95 / $1,122.02 / $2,344.23
| Professional | | $54.95 | $1,122.02 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $6,025.60 / $6,025.60 / $6,025.60
| Professional | 50 | $6,025.60 | $6,025.60 | $6,025.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,621.81 / $4,365.16 / $10,232.93
| Facility | | $1,621.81 | $4,365.16 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $53.70 / $102.33 / $2,041.74
| Professional | | $53.70 | $102.33 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $81.28 / $141.25 / $2,344.23
| Professional | 50 | $81.28 | $141.25 | $2,344.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $67.61 / $3,388.44 / $10,000.00
| Facility | | $67.61 | $3,388.44 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $56.23 / $1,071.52 / $3,162.28
| Professional | | $56.23 | $1,071.52 | $3,162.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $794.33 / $2,691.53 / $6,165.95
| Facility | | $794.33 | $2,691.53 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $53.70 / $1,000.00 / $2,290.87
| Professional | | $53.70 | $1,000.00 | $2,290.87 |