- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,047.13 / $4,570.88 / $11,481.54
| Facility | | $1,047.13 | $4,570.88 | $11,481.54 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $4,265.80 / $4,265.80 / $4,265.80
| Facility | 50 | $4,265.80 | $4,265.80 | $4,265.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,089.30 / $8,128.31 / $15,488.17
| Facility | | $2,089.30 | $8,128.31 | $15,488.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.59 / $2,344.23 / $6,456.54
| Facility | | $323.59 | $2,344.23 | $6,456.54 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $1,621.81 / $1,621.81 / $1,621.81
| Facility | 22 | $1,621.81 | $1,621.81 | $1,621.81 |
- 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
- $851.14 / $3,162.28 / $10,232.93
| Facility | | $851.14 | $3,162.28 | $10,232.93 |