- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,380.38 / $4,168.69 / $7,413.10
| Facility | | $1,380.38 | $4,168.69 | $7,413.10 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $1,862.09 / $2,511.89 / $9,332.54
| Facility | 50 | $1,862.09 | $2,511.89 | $9,332.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $3,311.31 / $6,025.60
| Facility | | $1,230.27 | $3,311.31 | $6,025.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,949.84 / $1,949.84 / $1,949.84
| Facility | | $1,949.84 | $1,949.84 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.68 / $537.03 / $2,089.30
| Professional | | $446.68 | $537.03 | $2,089.30 |
- Facility/Professional
- Professional
- Modifier
- AS
- Low / Median / High Price
- $15.49 / $15.49 / $15.49
| Professional | AS | $15.49 | $15.49 | $15.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $5,754.40 / $8,511.38
| Facility | | $1,513.56 | $5,754.40 | $8,511.38 |