- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,735.01 / $7,287.15 / $9,324.70
| Facility | | $3,735.01 | $7,287.15 | $9,324.70 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $6,114.72 / $8,254.78 / $13,801.19
| Facility | 50 | $6,114.72 | $8,254.78 | $13,801.19 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $1,045.35 / $1,045.35 / $1,045.35
| Facility | AS | $1,045.35 | $1,045.35 | $1,045.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $361.88 / $515.25 / $680.08
| Professional | | $361.88 | $515.25 | $680.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $492.44 / $579.67 / $843.66
| Professional | | $492.44 | $579.67 | $843.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $493.18 / $493.18 / $863.00
| Facility | | $493.18 | $493.18 | $863.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $48.91 / $48.91 / $48.91
| Facility | AS | $48.91 | $48.91 | $48.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $450.07 / $628.92 / $936.50
| Professional | | $450.07 | $628.92 | $936.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.54 / $630.48 / $986.59
| Professional | | $489.54 | $630.48 | $986.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $515.25 / $8,170.21 / $19,847.74
| Facility | | $515.25 | $8,170.21 | $19,847.74 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $3,394.47 / $9,655.70 / $28,919.32
| Facility | 50 | $3,394.47 | $9,655.70 | $28,919.32 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $1,045.35 / $1,045.35 / $1,045.35
| Facility | AS | $1,045.35 | $1,045.35 | $1,045.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.17 / $515.25 / $690.88
| Professional | | $416.17 | $515.25 | $690.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $417.61 / $596.08 / $904.45
| Professional | | $417.61 | $596.08 | $904.45 |