- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $877.55 / $2,749.30 / $9,145.50
| Facility | | $877.55 | $2,749.30 | $9,145.50 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $1,750.73 / $9,612.60 / $32,465.32
| Facility | 50 | $1,750.73 | $9,612.60 | $32,465.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,695.00 / $5,467.00 / $9,283.00
| Facility | | $2,695.00 | $5,467.00 | $9,283.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,109.74 / $15,214.55 / $26,542.00
| Facility | | $6,109.74 | $15,214.55 | $26,542.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $278.60 / $1,442.13 / $1,442.13
| Facility | AS | $278.60 | $1,442.13 | $1,442.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,799.00 / $6,073.00 / $10,111.00
| Facility | | $2,799.00 | $6,073.00 | $10,111.00 |