- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,492.22 / $3,695.07 / $8,074.63
| Facility | | $1,492.22 | $3,695.07 | $8,074.63 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $15,914.75 / $15,914.75 / $15,914.75
| Facility | 50 | $15,914.75 | $15,914.75 | $15,914.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,438.50 / $15,492.50 / $27,805.73
| Facility | | $7,438.50 | $15,492.50 | $27,805.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,725.96 / $1,725.96 / $2,419.21
| Facility | | $1,725.96 | $1,725.96 | $2,419.21 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $171.54 / $171.54 / $171.54
| Facility | AS | $171.54 | $171.54 | $171.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,292.00 / $3,325.00 / $8,198.00
| Facility | | $1,292.00 | $3,325.00 | $8,198.00 |