- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,258.93 / $6,165.95 / $12,589.25
| Facility | | $1,258.93 | $6,165.95 | $12,589.25 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $3,235.94 / $7,079.46 / $18,620.87
| Facility | 50 | $3,235.94 | $7,079.46 | $18,620.87 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $18,620.87 / $18,620.87 / $18,620.87
| Facility | AS | $18,620.87 | $18,620.87 | $18,620.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.58 / $812.83 / $2,884.03
| Professional | | $426.58 | $812.83 | $2,884.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,467.37 / $8,709.64 / $16,218.10
| Facility | | $3,467.37 | $8,709.64 | $16,218.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.86 / $812.83 / $1,479.11
| Professional | | $512.86 | $812.83 | $1,479.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $933.25 / $2,290.87 / $10,232.93
| Facility | | $933.25 | $2,290.87 | $10,232.93 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $93.33 / $93.33 / $93.33
| Facility | AS | $93.33 | $93.33 | $93.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $549.54 / $851.14 / $1,778.28
| Professional | | $549.54 | $851.14 | $1,778.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $5,754.40 / $12,302.69
| Facility | | $1,995.26 | $5,754.40 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.74 / $676.08 / $1,230.27
| Professional | | $467.74 | $676.08 | $1,230.27 |