- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,413.86 / $1,413.86 / $23,248.70
| Facility | | $1,413.86 | $1,413.86 | $23,248.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $806.24 / $2,653.59 / $23,248.70
| Professional | | $806.24 | $2,653.59 | $23,248.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,765.00 / $20,248.50 / $38,216.76
| Facility | | $6,765.00 | $20,248.50 | $38,216.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $491.83 / $1,901.40 / $9,242.78
| Professional | | $491.83 | $1,901.40 | $9,242.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $702.52 / $11,705.31 / $20,482.90
| Facility | | $702.52 | $11,705.31 | $20,482.90 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $1,351.73 / $17,993.64 / $23,663.89
| Facility | 50 | $1,351.73 | $17,993.64 | $23,663.89 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $126.16 / $1,679.41 / $2,208.63
| Facility | AS | $126.16 | $1,679.41 | $2,208.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,325.18 / $8,531.98 / $10,521.04
| Professional | | $5,325.18 | $8,531.98 | $10,521.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,479.94 / $8,326.35 / $12,502.64
| Professional | | $6,479.94 | $8,326.35 | $12,502.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9,340.87 / $12,560.14 / $24,744.02
| Professional | | $9,340.87 | $12,560.14 | $24,744.02 |