- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,258.93 / $6,025.60 / $14,791.08
| Facility | | $1,258.93 | $6,025.60 | $14,791.08 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $2,398.83 / $6,165.95 / $20,892.96
| Facility | 50 | $2,398.83 | $6,165.95 | $20,892.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,248.07 / $12,589.25 / $53,703.18
| Facility | | $5,248.07 | $12,589.25 | $53,703.18 |
- 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
- $6,165.95 / $12,022.64 / $22,908.68
| Facility | | $6,165.95 | $12,022.64 | $22,908.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,365.16 / $12,882.50 / $20,417.38
| Facility | | $4,365.16 | $12,882.50 | $20,417.38 |