- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,145.83 / $6,522.03 / $72,643.88
| Facility | | $1,145.83 | $6,522.03 | $72,643.88 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $18,449.38 / $32,875.56 / $80,942.61
| Facility | 50 | $18,449.38 | $32,875.56 | $80,942.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,041.42 / $1,405.92 / $1,718.34
| Facility | | $1,041.42 | $1,405.92 | $1,718.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,233.17 / $1,233.17 / $1,233.17
| Facility | | $1,233.17 | $1,233.17 | $1,233.17 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $122.40 / $122.40 / $122.40
| Facility | AS | $122.40 | $122.40 | $122.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,704.78 / $10,704.78 / $21,009.88
| Facility | | $10,704.78 | $10,704.78 | $21,009.88 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $6,891.47 / $27,004.26 / $61,260.24
| Facility | 50 | $6,891.47 | $27,004.26 | $61,260.24 |