- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $2,187.76 / $8,317.64
| Facility | | $630.96 | $2,187.76 | $8,317.64 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $4,365.16 / $4,365.16 / $4,365.16
| Facility | 22 | $4,365.16 | $4,365.16 | $4,365.16 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $812.83 / $3,715.35 / $6,760.83
| Facility | 50 | $812.83 | $3,715.35 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.05 / $630.96 / $3,090.30
| Professional | | $389.05 | $630.96 | $3,090.30 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $1,023.29 / $1,412.54 / $5,888.44
| Professional | 50 | $1,023.29 | $1,412.54 | $5,888.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.87 / $416.87 / $537.03
| Professional | | $223.87 | $416.87 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $363.08 / $549.54 / $660.69
| Professional | 50 | $363.08 | $549.54 | $660.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $3,090.30 / $4,677.35
| Facility | | $1,698.24 | $3,090.30 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.68 / $602.56 / $741.31
| Professional | | $446.68 | $602.56 | $741.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $39.81 / $1,548.82 / $1,548.82
| Facility | | $39.81 | $1,548.82 | $1,548.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $724.44 / $724.44 / $724.44
| Facility | | $724.44 | $724.44 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.58 / $562.34 / $758.58
| Professional | | $426.58 | $562.34 | $758.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.76 / $2,398.83 / $6,025.60
| Facility | | $831.76 | $2,398.83 | $6,025.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $478.63 / $870.96
| Professional | | $363.08 | $478.63 | $870.96 |