- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,241.22 / $9,544.15 / $20,928.72
| Facility | | $4,241.22 | $9,544.15 | $20,928.72 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $3,453.27 / $9,969.00 / $10,567.14
| Facility | 50 | $3,453.27 | $9,969.00 | $10,567.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,187.86 / $8,386.12 / $15,742.91
| Facility | | $6,187.86 | $8,386.12 | $15,742.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $787.64 / $1,368.34 / $9,653.94
| Facility | | $787.64 | $1,368.34 | $9,653.94 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $1,442.13 / $1,442.13 / $1,442.13
| Facility | AS | $1,442.13 | $1,442.13 | $1,442.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,407.65 / $1,799.19 / $4,968.71
| Facility | | $1,407.65 | $1,799.19 | $4,968.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,341.00 / $7,441.00 / $8,816.00
| Facility | | $5,341.00 | $7,441.00 | $8,816.00 |