- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,267.74 / $3,593.50 / $8,074.63
| Facility | | $1,267.74 | $3,593.50 | $8,074.63 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $5,867.70 / $11,857.84 / $11,857.84
| Facility | 50 | $5,867.70 | $11,857.84 | $11,857.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,989.73 / $8,668.10 / $13,628.92
| Facility | | $3,989.73 | $8,668.10 | $13,628.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,373.51 / $1,373.51 / $1,901.29
| Facility | | $1,373.51 | $1,373.51 | $1,901.29 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $134.81 / $134.81 / $134.81
| Facility | AS | $134.81 | $134.81 | $134.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,403.00 / $3,325.00 / $8,198.00
| Facility | | $1,403.00 | $3,325.00 | $8,198.00 |