- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $933.25 / $3,019.95 / $6,606.93
| Facility | | $933.25 | $3,019.95 | $6,606.93 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $11,220.18 / $13,803.84 / $13,803.84
| Facility | 50 | $11,220.18 | $13,803.84 | $13,803.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,951.21 / $6,025.60 / $8,511.38
| Facility | | $2,951.21 | $6,025.60 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $588.84 / $3,235.94 / $3,235.94
| Facility | | $588.84 | $3,235.94 | $3,235.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $724.44 / $1,584.89 / $2,454.71
| Facility | | $724.44 | $1,584.89 | $2,454.71 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $1,288.25 / $1,288.25 / $1,288.25
| Facility | 22 | $1,288.25 | $1,288.25 | $1,288.25 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $107.15 / $107.15 / $107.15
| Facility | AS | $107.15 | $107.15 | $107.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $912.01 / $3,162.28 / $8,511.38
| Facility | | $912.01 | $3,162.28 | $8,511.38 |