- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,996.28 / $4,505.00 / $9,185.68
| Facility | | $2,996.28 | $4,505.00 | $9,185.68 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $3,053.35 / $7,498.40 / $25,178.37
| Facility | 50 | $3,053.35 | $7,498.40 | $25,178.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,007.65 / $1,773.82 / $3,066.14
| Professional | | $1,007.65 | $1,773.82 | $3,066.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,786.18 / $2,936.43 / $15,214.55
| Facility | | $1,786.18 | $2,936.43 | $15,214.55 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $1,442.13 / $1,442.13 / $1,442.13
| Facility | AS | $1,442.13 | $1,442.13 | $1,442.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,925.00 / $3,272.34 / $4,945.14
| Facility | | $1,925.00 | $3,272.34 | $4,945.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,221.00 / $8,523.00 / $11,869.99
| Facility | | $7,221.00 | $8,523.00 | $11,869.99 |