- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,548.82 / $5,754.40 / $11,481.54
| Facility | | $1,548.82 | $5,754.40 | $11,481.54 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $1,445.44 / $5,248.07 / $9,549.93
| Facility | 50 | $1,445.44 | $5,248.07 | $9,549.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,165.95 / $8,128.31 / $15,848.93
| Facility | | $6,165.95 | $8,128.31 | $15,848.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $758.58 / $1,905.46 / $15,848.93
| Facility | | $758.58 | $1,905.46 | $15,848.93 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $1,698.24 / $1,698.24 / $1,698.24
| Facility | AS | $1,698.24 | $1,698.24 | $1,698.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,698.24 / $2,089.30 / $2,344.23
| Professional | | $1,698.24 | $2,089.30 | $2,344.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,079.46 / $8,511.38 / $10,964.78
| Facility | | $7,079.46 | $8,511.38 | $10,964.78 |