- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $933.25 / $4,168.69 / $11,748.98
| Facility | | $933.25 | $4,168.69 | $11,748.98 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $1,819.70 / $6,025.60 / $17,378.01
| Facility | 50 | $1,819.70 | $6,025.60 | $17,378.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,548.13 / $10,715.19 / $26,302.68
| Facility | | $3,548.13 | $10,715.19 | $26,302.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,288.25 / $2,630.27 / $12,882.50
| Facility | | $1,288.25 | $2,630.27 | $12,882.50 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $128.82 / $128.82 / $128.82
| Facility | AS | $128.82 | $128.82 | $128.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,019.95 / $8,912.51 / $20,892.96
| Facility | | $3,019.95 | $8,912.51 | $20,892.96 |