- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,463.27 / $5,547.90 / $11,561.00
| Facility | | $1,463.27 | $5,547.90 | $11,561.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $2,718.30 / $6,092.08 / $14,003.89
| Facility | 50 | $2,718.30 | $6,092.08 | $14,003.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,248.00 / $9,720.00 / $18,150.00
| Facility | | $4,248.00 | $9,720.00 | $18,150.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,547.76 / $6,841.82 / $9,144.09
| Facility | | $5,547.76 | $6,841.82 | $9,144.09 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $130.15 / $130.15 / $130.15
| Facility | AS | $130.15 | $130.15 | $130.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,062.00 / $8,220.00 / $15,648.00
| Facility | | $4,062.00 | $8,220.00 | $15,648.00 |