- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,273.51 / $7,813.07 / $26,580.07
| Facility | | $5,273.51 | $7,813.07 | $26,580.07 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $9,001.75 / $22,093.72 / $22,093.72
| Facility | 50 | $9,001.75 | $22,093.72 | $22,093.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $934.49 / $1,261.56 / $1,541.91
| Facility | | $934.49 | $1,261.56 | $1,541.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,090.83 / $1,090.83 / $1,090.83
| Facility | | $1,090.83 | $1,090.83 | $1,090.83 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $107.67 / $107.67 / $107.67
| Facility | AS | $107.67 | $107.67 | $107.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,038.65 / $15,316.20 / $30,678.93
| Facility | | $4,038.65 | $15,316.20 | $30,678.93 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $8,090.83 / $21,841.18 / $63,673.60
| Facility | 50 | $8,090.83 | $21,841.18 | $63,673.60 |