- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,387.00 / $23,394.53 / $35,581.62
| Facility | | $4,387.00 | $23,394.53 | $35,581.62 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $1,536.64 / $1,536.64 / $1,536.64
| Facility | 54 | $1,536.64 | $1,536.64 | $1,536.64 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $5,703.07 / $5,703.07 / $5,703.07
| Facility | AS | $5,703.07 | $5,703.07 | $5,703.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $836.81 / $1,607.11 / $6,153.00
| Professional | | $836.81 | $1,607.11 | $6,153.00 |
- Facility/Professional
- Professional
- Modifier
- AS
- Low / Median / High Price
- $40.00 / $355.47 / $946.77
| Professional | AS | $40.00 | $355.47 | $946.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,354.38 / $1,932.16 / $3,633.56
| Professional | | $1,354.38 | $1,932.16 | $3,633.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.43 / $752.91 / $1,195.62
| Professional | | $123.43 | $752.91 | $1,195.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20,314.50 / $25,330.44 / $36,365.48
| Facility | | $20,314.50 | $25,330.44 | $36,365.48 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $30,471.77 / $37,995.66 / $54,548.22
| Facility | 50 | $30,471.77 | $37,995.66 | $54,548.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,680.98 / $2,007.80 / $3,232.49
| Professional | | $1,680.98 | $2,007.80 | $3,232.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,340.00 / $10,927.00 / $47,431.00
| Facility | | $3,340.00 | $10,927.00 | $47,431.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,157.31 / $1,411.56 / $2,274.17
| Professional | | $1,157.31 | $1,411.56 | $2,274.17 |