- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,912.68 / $8,272.94 / $12,024.10
| Facility | | $1,912.68 | $8,272.94 | $12,024.10 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $6,305.60 / $8,232.00 / $12,766.94
| Facility | 50 | $6,305.60 | $8,232.00 | $12,766.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,038.29 / $12,420.70 / $23,075.19
| Facility | | $4,038.29 | $12,420.70 | $23,075.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $580.00 / $4,039.03 / $5,190.22
| Facility | | $580.00 | $4,039.03 | $5,190.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $738.51 / $1,075.01 / $1,839.72
| Facility | | $738.51 | $1,075.01 | $1,839.72 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $1,273.50 / $1,657.58 / $2,585.07
| Facility | 50 | $1,273.50 | $1,657.58 | $2,585.07 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $118.86 / $154.71 / $241.27
| Facility | AS | $118.86 | $154.71 | $241.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,028.00 / $19,526.00 / $25,620.00
| Facility | | $3,028.00 | $19,526.00 | $25,620.00 |