- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,259.91 / $4,840.00 / $12,000.00
| Facility | | $2,259.91 | $4,840.00 | $12,000.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $6,090.00 / $8,710.50 / $19,002.00
| Facility | 50 | $6,090.00 | $8,710.50 | $19,002.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $966.57 / $3,688.52 / $5,814.97
| Facility | | $966.57 | $3,688.52 | $5,814.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,795.94 / $9,795.94 / $9,795.94
| Facility | | $9,795.94 | $9,795.94 | $9,795.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,114.38 / $1,620.76 / $9,383.00
| Facility | | $1,114.38 | $1,620.76 | $9,383.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $297.92 / $2,858.74 / $2,858.74
| Facility | AS | $297.92 | $2,858.74 | $2,858.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,315.00 / $7,341.00 / $11,396.00
| Facility | | $5,315.00 | $7,341.00 | $11,396.00 |