- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.25 / $4,786.30 / $11,748.98
| Facility | | $891.25 | $4,786.30 | $11,748.98 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $1,122.02 / $2,754.23 / $12,302.69
| Facility | 50 | $1,122.02 | $2,754.23 | $12,302.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,754.23 / $7,585.78 / $14,791.08
| Facility | | $2,754.23 | $7,585.78 | $14,791.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $776.25 / $1,621.81 / $3,890.45
| Facility | | $776.25 | $1,621.81 | $3,890.45 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $77.62 / $77.62 / $77.62
| Facility | AS | $77.62 | $77.62 | $77.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $4,365.16 / $10,232.93
| Facility | | $1,584.89 | $4,365.16 | $10,232.93 |