- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $694.00 / $2,800.00 / $7,602.00
| Facility | | $694.00 | $2,800.00 | $7,602.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $1,448.00 / $2,118.50 / $5,538.00
| Facility | 50 | $1,448.00 | $2,118.50 | $5,538.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,430.00 / $7,133.00 / $13,734.00
| Facility | | $2,430.00 | $7,133.00 | $13,734.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,262.34 / $18,005.20 / $26,542.00
| Facility | | $4,262.34 | $18,005.20 | $26,542.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $195.23 / $1,706.64 / $1,706.64
| Facility | AS | $195.23 | $1,706.64 | $1,706.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,964.00 / $8,273.00 / $13,062.00
| Facility | | $3,964.00 | $8,273.00 | $13,062.00 |