- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $758.58 / $3,162.28 / $9,332.54
| Facility | | $758.58 | $3,162.28 | $9,332.54 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $4,168.69 / $6,918.31 / $10,000.00
| Facility | 50 | $4,168.69 | $6,918.31 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.63 / $676.08 / $1,288.25
| Professional | | $478.63 | $676.08 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $562.34 / $776.25
| Professional | | $281.84 | $562.34 | $776.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $5,888.44 / $8,511.38
| Facility | | $2,884.03 | $5,888.44 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $645.65 / $724.44 / $891.25
| Professional | | $645.65 | $724.44 | $891.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $489.78 / $2,884.03 / $2,884.03
| Facility | | $489.78 | $2,884.03 | $2,884.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $724.44 / $1,000.00 / $2,454.71
| Facility | | $724.44 | $1,000.00 | $2,454.71 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $1,071.52 / $1,071.52 / $1,071.52
| Facility | 22 | $1,071.52 | $1,071.52 | $1,071.52 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $89.13 / $89.13 / $89.13
| Facility | AS | $89.13 | $89.13 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.38 / $691.83 / $1,202.26
| Professional | | $407.38 | $691.83 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.25 / $3,162.28 / $8,511.38
| Facility | | $891.25 | $3,162.28 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.52 / $575.44 / $977.24
| Professional | | $436.52 | $575.44 | $977.24 |