- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $2,454.71 / $4,897.79
| Facility | | $1,000.00 | $2,454.71 | $4,897.79 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $4,677.35 / $6,456.54 / $19,498.45
| Facility | 50 | $4,677.35 | $6,456.54 | $19,498.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,754.23 / $6,456.54 / $9,772.37
| Facility | | $2,754.23 | $6,456.54 | $9,772.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,548.13 / $3,548.13 / $3,548.13
| Facility | | $3,548.13 | $3,548.13 | $3,548.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,135.61 / $15,135.61 / $33,884.42
| Facility | | $15,135.61 | $15,135.61 | $33,884.42 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $1,513.56 / $1,513.56 / $1,513.56
| Facility | AS | $1,513.56 | $1,513.56 | $1,513.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,754.23 / $4,570.88 / $7,585.78
| Facility | | $2,754.23 | $4,570.88 | $7,585.78 |