- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,380.38 / $5,495.41 / $14,125.38
| Facility | | $1,380.38 | $5,495.41 | $14,125.38 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $2,041.74 / $7,244.36 / $20,417.38
| Facility | 50 | $2,041.74 | $7,244.36 | $20,417.38 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $16,595.87 / $16,595.87 / $16,595.87
| Facility | AS | $16,595.87 | $16,595.87 | $16,595.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,630.78 / $11,220.18 / $26,302.68
| Facility | | $3,630.78 | $11,220.18 | $26,302.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,949.84 / $4,897.79 / $14,125.38
| Facility | | $1,949.84 | $4,897.79 | $14,125.38 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $194.98 / $194.98 / $194.98
| Facility | AS | $194.98 | $194.98 | $194.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,019.95 / $9,549.93 / $23,442.29
| Facility | | $3,019.95 | $9,549.93 | $23,442.29 |