- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $811.26 / $3,422.50 / $9,762.68
| Facility | | $811.26 | $3,422.50 | $9,762.68 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $977.00 / $2,385.84 / $3,567.66
| Facility | 50 | $977.00 | $2,385.84 | $3,567.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,948.00 / $14,105.00 / $28,800.00
| Facility | | $9,948.00 | $14,105.00 | $28,800.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $811.27 / $1,034.39 / $1,362.93
| Facility | | $811.27 | $1,034.39 | $1,362.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $984.55 / $1,212.97 / $1,559.53
| Professional | | $984.55 | $1,212.97 | $1,559.53 |
- Facility/Professional
- Professional
- Modifier
- AS
- Low / Median / High Price
- $21.42 / $21.42 / $21.42
| Professional | AS | $21.42 | $21.42 | $21.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,804.00 / $8,586.00 / $15,893.00
| Facility | | $3,804.00 | $8,586.00 | $15,893.00 |