- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,436.35 / $4,977.00 / $9,877.88
| Facility | | $2,436.35 | $4,977.00 | $9,877.88 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $6,521.43 / $6,674.38 / $8,239.82
| Facility | 50 | $6,521.43 | $6,674.38 | $8,239.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,499.00 / $13,274.50 / $23,636.43
| Facility | | $5,499.00 | $13,274.50 | $23,636.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,066.37 / $3,668.72 / $8,613.95
| Facility | | $3,066.37 | $3,668.72 | $8,613.95 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $1,892.76 / $1,892.76 / $1,892.76
| Facility | 62 | $1,892.76 | $1,892.76 | $1,892.76 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $302.83 / $302.83 / $302.83
| Facility | AS | $302.83 | $302.83 | $302.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,311.23 / $5,934.50 / $11,631.50
| Facility | | $2,311.23 | $5,934.50 | $11,631.50 |