- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,097.25 / $8,477.27 / $20,928.72
| Facility | | $5,097.25 | $8,477.27 | $20,928.72 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $11,400.00 / $11,400.00 / $11,400.00
| Facility | 50 | $11,400.00 | $11,400.00 | $11,400.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,823.60 / $13,313.50 / $24,992.84
| Facility | | $9,823.60 | $13,313.50 | $24,992.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.33 / $2,135.38 / $13,688.88
| Facility | | $1,096.33 | $2,135.38 | $13,688.88 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $2,569.69 / $2,569.69 / $2,569.69
| Facility | AS | $2,569.69 | $2,569.69 | $2,569.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,080.04 / $2,996.13 / $8,958.90
| Facility | | $2,080.04 | $2,996.13 | $8,958.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,178.00 / $7,441.00 / $8,816.00
| Facility | | $6,178.00 | $7,441.00 | $8,816.00 |