- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,113.30 / $1,113.30 / $10,738.39
| Facility | | $1,113.30 | $1,113.30 | $10,738.39 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $975.04 / $1,164.99 / $1,798.97
| Facility | 50 | $975.04 | $1,164.99 | $1,798.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,390.12 / $1,881.48 / $3,923.24
| Facility | | $1,390.12 | $1,881.48 | $3,923.24 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $4,882.08 / $4,882.08 / $4,882.08
| Facility | 50 | $4,882.08 | $4,882.08 | $4,882.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,537.00 / $3,189.35 / $12,410.26
| Facility | | $2,537.00 | $3,189.35 | $12,410.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,635.42 / $2,167.08 / $2,500.08
| Professional | | $1,635.42 | $2,167.08 | $2,500.08 |
- Facility/Professional
- Professional
- Modifier
- AS
- Low / Median / High Price
- $555.41 / $555.41 / $555.41
| Professional | AS | $555.41 | $555.41 | $555.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,357.00 / $5,357.00 / $5,357.00
| Facility | | $5,357.00 | $5,357.00 | $5,357.00 |