- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,010.30 / $8,042.03 / $16,762.57
| Facility | | $3,010.30 | $8,042.03 | $16,762.57 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $1,454.25 / $5,228.67 / $9,612.83
| Facility | 50 | $1,454.25 | $5,228.67 | $9,612.83 |
- 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
- $759.22 / $1,768.39 / $13,192.00
| Facility | | $759.22 | $1,768.39 | $13,192.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $1,706.64 / $1,706.64 / $1,706.64
| Facility | AS | $1,706.64 | $1,706.64 | $1,706.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,396.37 / $2,006.91 / $6,031.36
| Facility | | $1,396.37 | $2,006.91 | $6,031.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,777.00 / $8,220.00 / $9,696.00
| Facility | | $6,777.00 | $8,220.00 | $9,696.00 |