- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,380.38 / $3,235.94 / $8,511.38
| Facility | | $1,380.38 | $3,235.94 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $39.81 / $7,079.46 / $8,912.51
| Facility | 50 | $39.81 | $7,079.46 | $8,912.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,481.54 / $17,782.79 / $28,840.32
| Facility | | $11,481.54 | $17,782.79 | $28,840.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,174.90 / $5,128.61 / $15,848.93
| Facility | | $1,174.90 | $5,128.61 | $15,848.93 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $2,884.03 / $2,884.03 / $2,884.03
| Facility | AS | $2,884.03 | $2,884.03 | $2,884.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,949.84 / $7,943.28 / $15,135.61
| Facility | | $1,949.84 | $7,943.28 | $15,135.61 |