- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,177.66 / $4,366.59 / $8,732.47
| Facility | | $2,177.66 | $4,366.59 | $8,732.47 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $8,986.00 / $8,986.00 / $10,446.00
| Facility | 50 | $8,986.00 | $8,986.00 | $10,446.00 |
- 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
- $2,612.92 / $2,612.92 / $3,648.53
| Facility | | $2,612.92 | $2,612.92 | $3,648.53 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $258.70 / $258.70 / $258.70
| Facility | AS | $258.70 | $258.70 | $258.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,403.00 / $3,325.00 / $8,198.00
| Facility | | $1,403.00 | $3,325.00 | $8,198.00 |