- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,223.59 / $3,457.38 / $8,140.50
| Facility | | $1,223.59 | $3,457.38 | $8,140.50 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $1,059.74 / $5,644.50 / $15,820.32
| Facility | 50 | $1,059.74 | $5,644.50 | $15,820.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,302.00 / $8,423.00 / $15,167.00
| Facility | | $3,302.00 | $8,423.00 | $15,167.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,487.20 / $26,542.00 / $30,159.95
| Facility | | $6,487.20 | $26,542.00 | $30,159.95 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $297.92 / $2,858.74 / $2,858.74
| Facility | AS | $297.92 | $2,858.74 | $2,858.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,964.00 / $8,273.00 / $13,062.00
| Facility | | $3,964.00 | $8,273.00 | $13,062.00 |