- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,981.07 / $11,220.18 / $29,512.09
| Facility | | $3,981.07 | $11,220.18 | $29,512.09 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $8,511.38 / $8,511.38 / $33,884.42
| Facility | 50 | $8,511.38 | $8,511.38 | $33,884.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,174.90 / $2,884.03 / $30,199.52
| Professional | | $1,174.90 | $2,884.03 | $30,199.52 |
- Facility/Professional
- Professional
- Modifier
- AS
- Low / Median / High Price
- $158.49 / $229.09 / $794.33
| Professional | AS | $158.49 | $229.09 | $794.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,220.18 / $11,220.18 / $11,220.18
| Facility | | $11,220.18 | $11,220.18 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,951.21 / $4,466.84 / $4,466.84
| Professional | | $2,951.21 | $4,466.84 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,778.28 / $2,511.89 / $3,548.13
| Professional | | $1,778.28 | $2,511.89 | $3,548.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,511.38 / $12,022.64 / $26,915.35
| Facility | | $8,511.38 | $12,022.64 | $26,915.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,621.81 / $2,511.89 / $6,025.60
| Professional | | $1,621.81 | $2,511.89 | $6,025.60 |