- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,404.38 / $5,463.36 / $7,943.37
| Facility | | $3,404.38 | $5,463.36 | $7,943.37 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $17,549.32 / $17,549.32 / $17,549.32
| Facility | 50 | $17,549.32 | $17,549.32 | $17,549.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,200.42 / $1,977.19 / $5,208.52
| Professional | | $1,200.42 | $1,977.19 | $5,208.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,791.78 / $3,223.94 / $14,479.00
| Facility | | $1,791.78 | $3,223.94 | $14,479.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $1,887.52 / $1,887.52 / $1,887.52
| Facility | AS | $1,887.52 | $1,887.52 | $1,887.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,401.00 / $3,430.40 / $6,616.19
| Facility | | $2,401.00 | $3,430.40 | $6,616.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,220.00 / $9,259.00 / $14,242.22
| Facility | | $8,220.00 | $9,259.00 | $14,242.22 |