- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $4,897.79 / $12,589.25
| Facility | | $501.19 | $4,897.79 | $12,589.25 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $1,949.84 / $4,168.69 / $9,549.93
| Facility | 50 | $1,949.84 | $4,168.69 | $9,549.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,548.13 / $6,606.93 / $14,125.38
| Facility | | $3,548.13 | $6,606.93 | $14,125.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $776.25 / $15,488.17
| Facility | | $398.11 | $776.25 | $15,488.17 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $39.81 / $39.81 / $39.81
| Facility | AS | $39.81 | $39.81 | $39.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $269.15 / $1,288.25 / $6,456.54
| Facility | | $269.15 | $1,288.25 | $6,456.54 |