- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,318.26 / $5,754.40 / $25,118.86
| Facility | | $1,318.26 | $5,754.40 | $25,118.86 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $3,162.28 / $3,388.44 / $5,754.40
| Facility | 50 | $3,162.28 | $3,388.44 | $5,754.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,202.26 / $2,238.72 / $28,183.83
| Professional | | $1,202.26 | $2,238.72 | $28,183.83 |
- Facility/Professional
- Professional
- Modifier
- AS
- Low / Median / High Price
- $165.96 / $309.03 / $660.69
| Professional | AS | $165.96 | $309.03 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.49 / $1,148.15 / $1,621.81
| Professional | | $158.49 | $1,148.15 | $1,621.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,912.51 / $15,488.17 / $27,542.29
| Facility | | $8,912.51 | $15,488.17 | $27,542.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,380.38 / $1,778.28 / $2,089.30
| Professional | | $1,380.38 | $1,778.28 | $2,089.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $39.81 / $11,481.54 / $11,481.54
| Facility | | $39.81 | $11,481.54 | $11,481.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $398.11 / $398.11
| Facility | | $398.11 | $398.11 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,230.27 / $1,949.84 / $2,570.40
| Professional | | $1,230.27 | $1,949.84 | $2,570.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.26 / $10,232.93 / $25,703.96
| Facility | | $1,202.26 | $10,232.93 | $25,703.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,174.90 / $1,584.89 / $2,511.89
| Professional | | $1,174.90 | $1,584.89 | $2,511.89 |