- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,511.89 / $5,888.44 / $9,549.93
| Facility | | $2,511.89 | $5,888.44 | $9,549.93 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $4,168.69 / $7,762.47 / $12,302.69
| Facility | 50 | $4,168.69 | $7,762.47 | $12,302.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $4,265.80 / $12,022.64
| Facility | | $1,698.24 | $4,265.80 | $12,022.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,011.87 / $7,244.36 / $9,772.37
| Facility | | $5,011.87 | $7,244.36 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,096.48 / $1,348.96 / $3,090.30
| Professional | | $1,096.48 | $1,348.96 | $3,090.30 |
- Facility/Professional
- Professional
- Modifier
- AS
- Low / Median / High Price
- $35.48 / $35.48 / $35.48
| Professional | AS | $35.48 | $35.48 | $35.48 |
- 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 |