- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,290.87 / $7,943.28 / $14,454.40
| Facility | | $2,290.87 | $7,943.28 | $14,454.40 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $3,801.89 / $3,801.89 / $3,801.89
| Facility | 50 | $3,801.89 | $3,801.89 | $3,801.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,549.93 / $12,302.69 / $23,988.33
| Facility | | $9,549.93 | $12,302.69 | $23,988.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,148.15 / $2,454.71 / $10,964.78
| Facility | | $1,148.15 | $2,454.71 | $10,964.78 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $1,445.44 / $1,445.44 / $1,445.44
| Facility | AS | $1,445.44 | $1,445.44 | $1,445.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,570.40 / $2,691.53 / $3,715.35
| Professional | | $2,570.40 | $2,691.53 | $3,715.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,309.57 / $7,413.10 / $9,120.11
| Facility | | $6,309.57 | $7,413.10 | $9,120.11 |