- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.26 / $5,495.41 / $14,454.40
| Facility | | $1,202.26 | $5,495.41 | $14,454.40 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $3,890.45 / $11,481.54 / $61,659.50
| Facility | 50 | $3,890.45 | $11,481.54 | $61,659.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,365.16 / $11,481.54 / $28,840.32
| Facility | | $4,365.16 | $11,481.54 | $28,840.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $2,137.96 / $15,848.93
| Facility | | $630.96 | $2,137.96 | $15,848.93 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $138.04 / $138.04 / $138.04
| Facility | AS | $138.04 | $138.04 | $138.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,630.78 / $11,748.98 / $28,183.83
| Facility | | $3,630.78 | $11,748.98 | $28,183.83 |