- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,905.46 / $7,413.10 / $20,892.96
| Facility | | $1,905.46 | $7,413.10 | $20,892.96 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $6,165.95 / $7,762.47 / $35,481.34
| Facility | 50 | $6,165.95 | $7,762.47 | $35,481.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,148.15 / $1,698.24 / $3,467.37
| Professional | | $1,148.15 | $1,698.24 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- AS
- Low / Median / High Price
- $162.18 / $338.84 / $954.99
| Professional | AS | $162.18 | $338.84 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.88 / $1,230.27 / $1,737.80
| Professional | | $154.88 | $1,230.27 | $1,737.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,630.78 / $8,128.31 / $13,489.63
| Facility | | $3,630.78 | $8,128.31 | $13,489.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,548.82 / $2,454.71 / $25,703.96
| Professional | | $1,548.82 | $2,454.71 | $25,703.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30.20 / $30.20 / $30.20
| Facility | | $30.20 | $30.20 | $30.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,318.26 / $1,905.46 / $2,884.03
| Professional | | $1,318.26 | $1,905.46 | $2,884.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,054.61 / $52,480.75 / $52,480.75
| Facility | | $19,054.61 | $52,480.75 | $52,480.75 |
- Facility/Professional
- Facility
- Modifier
- 54
- Low / Median / High Price
- $37,153.52 / $37,153.52 / $37,153.52
| Facility | 54 | $37,153.52 | $37,153.52 | $37,153.52 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $5,248.07 / $5,248.07 / $5,248.07
| Facility | AS | $5,248.07 | $5,248.07 | $5,248.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11,220.18 / $11,220.18 / $11,220.18
| Professional | | $11,220.18 | $11,220.18 | $11,220.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,456.54 / $14,791.08 / $27,542.29
| Facility | | $6,456.54 | $14,791.08 | $27,542.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,202.26 / $1,698.24 / $2,818.38
| Professional | | $1,202.26 | $1,698.24 | $2,818.38 |