- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.23 / $7,943.28 / $17,782.79
| Facility | | $2,344.23 | $7,943.28 | $17,782.79 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $1,174.90 / $5,623.41 / $11,220.18
| Facility | 50 | $1,174.90 | $5,623.41 | $11,220.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,549.93 / $12,589.25 / $23,988.33
| Facility | | $9,549.93 | $12,589.25 | $23,988.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,148.15 / $3,162.28 / $28,840.32
| Facility | | $1,148.15 | $3,162.28 | $28,840.32 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $10,471.29 / $26,302.68 / $61,659.50
| Facility | 50 | $10,471.29 | $26,302.68 | $61,659.50 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $2,884.03 / $2,884.03 / $2,884.03
| Facility | AS | $2,884.03 | $2,884.03 | $2,884.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,570.40 / $3,388.44 / $3,548.13
| Professional | | $2,570.40 | $3,388.44 | $3,548.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,079.46 / $9,772.37 / $18,197.01
| Facility | | $7,079.46 | $9,772.37 | $18,197.01 |