- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,073.00 / $4,474.00 / $7,960.15
| Facility | | $2,073.00 | $4,474.00 | $7,960.15 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $4,453.50 / $8,773.50 / $8,773.50
| Facility | 50 | $4,453.50 | $8,773.50 | $8,773.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,310.70 / $5,330.69 / $8,174.14
| Facility | | $1,310.70 | $5,330.69 | $8,174.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,238.21 / $1,628.98 / $9,729.00
| Facility | | $1,238.21 | $1,628.98 | $9,729.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $320.52 / $320.52 / $1,887.52
| Facility | AS | $320.52 | $320.52 | $1,887.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,279.00 / $7,499.00 / $11,396.00
| Facility | | $5,279.00 | $7,499.00 | $11,396.00 |