- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,737.80 / $4,677.35 / $8,128.31
| Facility | | $1,737.80 | $4,677.35 | $8,128.31 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $4,365.16 / $4,365.16 / $4,365.16
| Facility | 50 | $4,365.16 | $4,365.16 | $4,365.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $616.60 / $2,041.74 / $3,019.95
| Facility | | $616.60 | $2,041.74 | $3,019.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $208.93 / $309.03 / $7,244.36
| Facility | | $208.93 | $309.03 | $7,244.36 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $56.23 / $56.23 / $104.71
| Facility | AS | $56.23 | $56.23 | $104.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $707.95 / $2,089.30 / $8,912.51
| Facility | | $707.95 | $2,089.30 | $8,912.51 |