- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,157.56 / $5,167.00 / $11,535.00
| Facility | | $1,157.56 | $5,167.00 | $11,535.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $12,110.12 / $12,110.12 / $14,848.87
| Facility | 50 | $12,110.12 | $12,110.12 | $14,848.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,479.00 / $10,576.00 / $24,019.00
| Facility | | $8,479.00 | $10,576.00 | $24,019.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $909.46 / $1,089.89 / $16,309.45
| Facility | | $909.46 | $1,089.89 | $16,309.45 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $90.07 / $90.07 / $90.07
| Facility | AS | $90.07 | $90.07 | $90.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,505.00 / $10,133.00 / $19,562.00
| Facility | | $4,505.00 | $10,133.00 | $19,562.00 |