- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,122.02 / $5,248.07 / $10,715.19
| Facility | | $1,122.02 | $5,248.07 | $10,715.19 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $977.24 / $1,513.56 / $1,819.70
| Facility | 50 | $977.24 | $1,513.56 | $1,819.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,412.54 / $2,454.71 / $5,370.32
| Facility | | $1,412.54 | $2,454.71 | $5,370.32 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $4,897.79 / $4,897.79 / $4,897.79
| Facility | 50 | $4,897.79 | $4,897.79 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,570.40 / $3,162.28 / $3,388.44
| Professional | | $2,570.40 | $3,162.28 | $3,388.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,621.81 / $2,187.76 / $2,570.40
| Professional | | $1,621.81 | $2,187.76 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- AS
- Low / Median / High Price
- $575.44 / $575.44 / $575.44
| Professional | AS | $575.44 | $575.44 | $575.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,370.32 / $5,370.32 / $5,370.32
| Facility | | $5,370.32 | $5,370.32 | $5,370.32 |