- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $5,888.44 / $14,791.08
| Facility | | $1,096.48 | $5,888.44 | $14,791.08 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $2,630.27 / $7,244.36 / $17,378.01
| Facility | 50 | $2,630.27 | $7,244.36 | $17,378.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,548.13 / $8,709.64 / $20,417.38
| Facility | | $3,548.13 | $8,709.64 | $20,417.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $2,511.89 / $9,772.37
| Facility | | $1,000.00 | $2,511.89 | $9,772.37 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $125.89 / $125.89 / $125.89
| Facility | AS | $125.89 | $125.89 | $125.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,019.95 / $8,709.64 / $19,054.61
| Facility | | $3,019.95 | $8,709.64 | $19,054.61 |