- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,490.19 / $4,655.50 / $10,356.71
| Facility | | $1,490.19 | $4,655.50 | $10,356.71 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $4,855.62 / $4,855.62 / $4,953.48
| Facility | 50 | $4,855.62 | $4,855.62 | $4,953.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,247.00 / $15,171.60 / $55,752.34
| Facility | | $4,247.00 | $15,171.60 | $55,752.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $895.00 / $950.00 / $1,548.07
| Facility | | $895.00 | $950.00 | $1,548.07 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $153.38 / $153.38 / $153.38
| Facility | AS | $153.38 | $153.38 | $153.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,505.00 / $10,133.00 / $19,562.00
| Facility | | $4,505.00 | $10,133.00 | $19,562.00 |