- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,162.28 / $8,128.31 / $27,542.29
| Facility | | $3,162.28 | $8,128.31 | $27,542.29 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $52,480.75 / $52,480.75 / $52,480.75
| Facility | 50 | $52,480.75 | $52,480.75 | $52,480.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,096.48 / $1,778.28 / $3,388.44
| Professional | | $1,096.48 | $1,778.28 | $3,388.44 |
- Facility/Professional
- Professional
- Modifier
- AS
- Low / Median / High Price
- $162.18 / $239.88 / $691.83
| Professional | AS | $162.18 | $239.88 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.91 / $1,047.13 / $1,548.82
| Professional | | $147.91 | $1,047.13 | $1,548.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,135.61 / $16,218.10 / $31,622.78
| Facility | | $15,135.61 | $16,218.10 | $31,622.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,398.83 / $2,398.83 / $2,398.83
| Professional | | $2,398.83 | $2,398.83 | $2,398.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $16,218.10 / $16,218.10
| Facility | | $630.96 | $16,218.10 | $16,218.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,348.96 / $1,905.46 / $2,818.38
| Professional | | $1,348.96 | $1,905.46 | $2,818.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,288.25 / $2,137.96 / $24,547.09
| Facility | | $1,288.25 | $2,137.96 | $24,547.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,380.38 / $1,778.28 / $13,489.63
| Professional | | $1,380.38 | $1,778.28 | $13,489.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,311.31 / $10,471.29 / $18,620.87
| Facility | | $3,311.31 | $10,471.29 | $18,620.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,348.96 / $1,621.81 / $2,238.72
| Professional | | $1,348.96 | $1,621.81 | $2,238.72 |