- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $751.34 / $3,640.00 / $8,213.50
| Facility | | $751.34 | $3,640.00 | $8,213.50 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $5,368.10 / $5,368.10 / $7,028.27
| Facility | 50 | $5,368.10 | $5,368.10 | $7,028.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,248.00 / $5,196.00 / $10,517.23
| Facility | | $3,248.00 | $5,196.00 | $10,517.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $750.84 / $1,379.47 / $2,070.38
| Facility | | $750.84 | $1,379.47 | $2,070.38 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $53.24 / $53.24 / $53.24
| Facility | AS | $53.24 | $53.24 | $53.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,200.00 / $5,111.00 / $9,202.00
| Facility | | $2,200.00 | $5,111.00 | $9,202.00 |