- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $948.11 / $3,883.44 / $9,239.18
| Facility | | $948.11 | $3,883.44 | $9,239.18 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $2,505.67 / $5,855.43 / $11,442.15
| Facility | 50 | $2,505.67 | $5,855.43 | $11,442.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,248.00 / $9,559.00 / $18,150.00
| Facility | | $4,248.00 | $9,559.00 | $18,150.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,343.67 / $4,383.72 / $5,861.91
| Facility | | $3,343.67 | $4,383.72 | $5,861.91 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $85.49 / $85.49 / $85.49
| Facility | AS | $85.49 | $85.49 | $85.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,062.00 / $8,220.00 / $15,090.00
| Facility | | $4,062.00 | $8,220.00 | $15,090.00 |