- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,479.11 / $5,495.41 / $13,182.57
| Facility | | $1,479.11 | $5,495.41 | $13,182.57 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $4,365.16 / $4,365.16 / $5,370.32
| Facility | 50 | $4,365.16 | $4,365.16 | $5,370.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,235.94 / $8,511.38 / $16,595.87
| Facility | | $3,235.94 | $8,511.38 | $16,595.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $2,344.23 / $9,332.54
| Facility | | $398.11 | $2,344.23 | $9,332.54 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $234.42 / $234.42 / $234.42
| Facility | AS | $234.42 | $234.42 | $234.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,548.13 / $11,481.54 / $28,840.32
| Facility | | $3,548.13 | $11,481.54 | $28,840.32 |