- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,348.96 / $4,677.35 / $12,882.50
| Facility | | $1,348.96 | $4,677.35 | $12,882.50 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $1,698.24 / $1,698.24 / $4,365.16
| Facility | 50 | $1,698.24 | $1,698.24 | $4,365.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,570.88 / $11,481.54 / $23,988.33
| Facility | | $4,570.88 | $11,481.54 | $23,988.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,380.38 / $3,630.78 / $23,442.29
| Facility | | $1,380.38 | $3,630.78 | $23,442.29 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $186.21 / $186.21 / $186.21
| Facility | AS | $186.21 | $186.21 | $186.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,019.95 / $8,709.64 / $19,952.62
| Facility | | $3,019.95 | $8,709.64 | $19,952.62 |