- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $389.05 / $2,511.89 / $8,128.31
| Facility | | $389.05 | $2,511.89 | $8,128.31 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $794.33 / $2,041.74 / $5,011.87
| Facility | 50 | $794.33 | $2,041.74 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $354.81 / $933.25
| Professional | | $234.42 | $354.81 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $407.38 / $812.83 / $1,778.28
| Professional | 50 | $407.38 | $812.83 | $1,778.28 |
- Facility/Professional
- Professional
- Modifier
- 54
- Low / Median / High Price
- $275.42 / $380.19 / $380.19
| Professional | 54 | $275.42 | $380.19 | $380.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,621.81 / $3,890.45 / $9,549.93
| Facility | | $1,621.81 | $3,890.45 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $380.19 / $741.31
| Professional | | $245.47 | $380.19 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $371.54 / $549.54 / $1,000.00
| Professional | 50 | $371.54 | $549.54 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $186.21 / $457.09 / $2,238.72
| Facility | | $186.21 | $457.09 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $269.15 / $269.15 / $269.15
| Facility | 54 | $269.15 | $269.15 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.88 / $407.38 / $870.96
| Professional | | $239.88 | $407.38 | $870.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $467.74 / $1,862.09 / $4,677.35
| Facility | | $467.74 | $1,862.09 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.87 / $346.74 / $602.56
| Professional | | $223.87 | $346.74 | $602.56 |