- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,128.61 / $8,128.31 / $12,022.64
| Facility | | $5,128.61 | $8,128.31 | $12,022.64 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $8,912.51 / $10,715.19 / $14,454.40
| Facility | 50 | $8,912.51 | $10,715.19 | $14,454.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.74 / $676.08 / $1,548.82
| Professional | | $467.74 | $676.08 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.74 / $676.08 / $1,122.02
| Professional | | $467.74 | $676.08 | $1,122.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $870.96 / $870.96 / $891.25
| Facility | | $870.96 | $870.96 | $891.25 |
- 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
- $416.87 / $676.08 / $1,230.27
| Professional | | $416.87 | $676.08 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $616.60 / $891.25 / $1,584.89
| Professional | | $616.60 | $891.25 | $1,584.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,890.45 / $7,762.47 / $12,022.64
| Facility | | $3,890.45 | $7,762.47 | $12,022.64 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $8,912.51 / $10,715.19 / $19,498.45
| Facility | 50 | $8,912.51 | $10,715.19 | $19,498.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $501.19 / $776.25 / $1,584.89
| Professional | | $501.19 | $776.25 | $1,584.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.86 / $724.44 / $1,174.90
| Professional | | $512.86 | $724.44 | $1,174.90 |