- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $948.61 / $4,215.00 / $9,403.29
| Facility | | $948.61 | $4,215.00 | $9,403.29 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $3,453.27 / $7,508.48 / $10,567.14
| Facility | 50 | $3,453.27 | $7,508.48 | $10,567.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,583.00 / $9,030.00 / $17,951.00
| Facility | | $4,583.00 | $9,030.00 | $17,951.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,108.48 / $3,400.69 / $4,118.10
| Facility | | $3,108.48 | $3,400.69 | $4,118.10 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $88.96 / $88.96 / $88.96
| Facility | AS | $88.96 | $88.96 | $88.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,637.00 / $5,735.00 / $9,622.00
| Facility | | $2,637.00 | $5,735.00 | $9,622.00 |