- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $853.00 / $3,466.50 / $7,602.00
| Facility | | $853.00 | $3,466.50 | $7,602.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $1,744.20 / $4,643.10 / $11,546.08
| Facility | 50 | $1,744.20 | $4,643.10 | $11,546.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,695.00 / $5,500.00 / $9,283.00
| Facility | | $2,695.00 | $5,500.00 | $9,283.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,590.04 / $15,214.55 / $26,542.00
| Facility | | $3,590.04 | $15,214.55 | $26,542.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $238.29 / $1,442.13 / $1,442.13
| Facility | AS | $238.29 | $1,442.13 | $1,442.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,259.00 / $4,567.00 / $7,669.00
| Facility | | $2,259.00 | $4,567.00 | $7,669.00 |