- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,859.44 / $5,602.52 / $8,937.78
| Facility | | $3,859.44 | $5,602.52 | $8,937.78 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $8,914.10 / $8,914.10 / $14,339.32
| Facility | 50 | $8,914.10 | $8,914.10 | $14,339.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $440.05 / $624.44 / $816.07
| Professional | | $440.05 | $624.44 | $816.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $557.00 / $639.57 / $1,005.93
| Professional | | $557.00 | $639.57 | $1,005.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $596.21 / $596.21 / $863.00
| Facility | | $596.21 | $596.21 | $863.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $58.98 / $58.98 / $58.98
| Facility | AS | $58.98 | $58.98 | $58.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $486.78 / $759.16 / $1,137.11
| Professional | | $486.78 | $759.16 | $1,137.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $590.26 / $760.21 / $1,189.58
| Professional | | $590.26 | $760.21 | $1,189.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,188.14 / $7,755.56 / $10,510.21
| Facility | | $5,188.14 | $7,755.56 | $10,510.21 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $8,461.74 / $10,656.82 / $19,645.54
| Facility | 50 | $8,461.74 | $10,656.82 | $19,645.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $506.05 / $624.44 / $966.79
| Professional | | $506.05 | $624.44 | $966.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $516.78 / $725.17 / $1,129.01
| Professional | | $516.78 | $725.17 | $1,129.01 |