- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.25 / $3,801.89 / $7,413.10
| Facility | | $891.25 | $3,801.89 | $7,413.10 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $2,511.89 / $4,466.84 / $9,120.11
| Facility | 50 | $2,511.89 | $4,466.84 | $9,120.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,258.93 / $4,265.80 / $12,022.64
| Facility | | $1,258.93 | $4,265.80 | $12,022.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,168.69 / $7,244.36 / $9,772.37
| Facility | | $4,168.69 | $7,244.36 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $707.95 / $870.96 / $2,454.71
| Professional | | $707.95 | $870.96 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- AS
- Low / Median / High Price
- $23.44 / $23.44 / $23.44
| Professional | AS | $23.44 | $23.44 | $23.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $7,762.47 / $18,620.87
| Facility | | $1,995.26 | $7,762.47 | $18,620.87 |