- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $741.31 / $3,801.89 / $10,471.29
| Facility | | $741.31 | $3,801.89 | $10,471.29 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $1,737.80 / $4,466.84 / $11,220.18
| Facility | 50 | $1,737.80 | $4,466.84 | $11,220.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,187.76 / $5,888.44 / $13,803.84
| Facility | | $2,187.76 | $5,888.44 | $13,803.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $436.52 / $1,318.26 / $3,801.89
| Facility | | $436.52 | $1,318.26 | $3,801.89 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $75.86 / $75.86 / $75.86
| Facility | AS | $75.86 | $75.86 | $75.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,905.46 / $5,623.41 / $12,882.50
| Facility | | $1,905.46 | $5,623.41 | $12,882.50 |