- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,414.00 / $3,133.00 / $9,872.00
| Facility | | $1,414.00 | $3,133.00 | $9,872.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $2,994.50 / $2,994.50 / $2,994.50
| Facility | 50 | $2,994.50 | $2,994.50 | $2,994.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $189.24 / $934.25 / $3,831.30
| Professional | | $189.24 | $934.25 | $3,831.30 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $1,059.21 / $1,059.21 / $1,059.21
| Professional | 50 | $1,059.21 | $1,059.21 | $1,059.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,948.00 / $14,105.00 / $28,800.00
| Facility | | $9,948.00 | $14,105.00 | $28,800.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $217.99 / $1,357.71 / $3,360.58
| Professional | | $217.99 | $1,357.71 | $3,360.58 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $220.17 / $2,036.57 / $3,263.42
| Professional | 50 | $220.17 | $2,036.57 | $3,263.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $258.45 / $528.71 / $4,604.02
| Professional | | $258.45 | $528.71 | $4,604.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $211.59 / $1,621.52 / $3,440.58
| Facility | | $211.59 | $1,621.52 | $3,440.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $230.98 / $662.61 / $2,880.97
| Professional | | $230.98 | $662.61 | $2,880.97 |
- Facility/Professional
- Professional
- Modifier
- AS
- Low / Median / High Price
- $4.80 / $4.80 / $44.11
| Professional | AS | $4.80 | $4.80 | $44.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,527.00 / $8,586.00 / $15,893.00
| Facility | | $3,527.00 | $8,586.00 | $15,893.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,338.40 / $3,570.60 / $6,721.19
| Professional | | $2,338.40 | $3,570.60 | $6,721.19 |