- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $467.74 / $2,454.71 / $8,511.38
| Facility | | $467.74 | $2,454.71 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $1,230.27 / $4,786.30 / $13,489.63
| Facility | 50 | $1,230.27 | $4,786.30 | $13,489.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.23 / $588.84 / $1,778.28
| Professional | | $316.23 | $588.84 | $1,778.28 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $741.31 / $1,174.90 / $4,897.79
| Professional | 50 | $741.31 | $1,174.90 | $4,897.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,548.82 / $3,715.35 / $9,332.54
| Facility | | $1,548.82 | $3,715.35 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.03 / $616.60 / $1,659.59
| Professional | | $309.03 | $616.60 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $446.68 / $812.83 / $2,238.72
| Professional | 50 | $446.68 | $812.83 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $186.21 / $1,000.00 / $7,413.10
| Facility | | $186.21 | $1,000.00 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.00 / $676.08 / $1,445.44
| Professional | | $302.00 | $676.08 | $1,445.44 |
- 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
- $281.84 / $524.81 / $1,288.25
| Professional | | $281.84 | $524.81 | $1,288.25 |