- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,404.39 / $5,377.35 / $11,986.00
| Facility | | $1,404.39 | $5,377.35 | $11,986.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $6,790.39 / $8,693.00 / $12,655.41
| Facility | 50 | $6,790.39 | $8,693.00 | $12,655.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,583.00 / $9,458.00 / $18,294.00
| Facility | | $4,583.00 | $9,458.00 | $18,294.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,167.51 / $3,519.14 / $4,663.73
| Facility | | $3,167.51 | $3,519.14 | $4,663.73 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $132.54 / $132.54 / $132.54
| Facility | AS | $132.54 | $132.54 | $132.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,206.00 / $6,876.00 / $12,494.00
| Facility | | $3,206.00 | $6,876.00 | $12,494.00 |