- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,398.83 / $3,388.44 / $14,791.08
| Facility | | $2,398.83 | $3,388.44 | $14,791.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.09 / $3,235.94 / $4,466.84
| Professional | | $229.09 | $3,235.94 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $14,125.38 / $14,125.38 / $14,791.08
| Professional | 50 | $14,125.38 | $14,125.38 | $14,791.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,912.51 / $10,000.00 / $18,197.01
| Facility | | $8,912.51 | $10,000.00 | $18,197.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.80 / $602.56 / $5,888.44
| Professional | | $213.80 | $602.56 | $5,888.44 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $323.59 / $891.25 / $8,912.51
| Professional | 50 | $323.59 | $891.25 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- AS
- Low / Median / High Price
- $30.20 / $83.18 / $831.76
| Professional | AS | $30.20 | $83.18 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.59 / $758.58 / $9,120.11
| Professional | | $323.59 | $758.58 | $9,120.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,000.00 / $10,000.00 / $10,000.00
| Facility | | $10,000.00 | $10,000.00 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.03 / $3,235.94 / $7,413.10
| Professional | | $263.03 | $3,235.94 | $7,413.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,000.00 / $10,000.00 / $10,000.00
| Facility | | $10,000.00 | $10,000.00 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $3,235.94 / $9,772.37
| Professional | | $346.74 | $3,235.94 | $9,772.37 |