- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.25 / $4,168.69 / $6,760.83
| Facility | | $891.25 | $4,168.69 | $6,760.83 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $3,019.95 / $6,606.93 / $19,498.45
| Facility | 50 | $3,019.95 | $6,606.93 | $19,498.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,071.52 / $1,862.09 / $6,456.54
| Professional | | $1,071.52 | $1,862.09 | $6,456.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,778.28 / $4,168.69 / $16,595.87
| Facility | | $1,778.28 | $4,168.69 | $16,595.87 |
- 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
- $2,398.83 / $2,570.40 / $3,890.45
| Professional | | $2,398.83 | $2,570.40 | $3,890.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,413.10 / $10,715.19 / $17,378.01
| Facility | | $7,413.10 | $10,715.19 | $17,378.01 |