- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,048.00 / $3,803.00 / $12,600.00
| Facility | | $1,048.00 | $3,803.00 | $12,600.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $1,833.72 / $1,833.72 / $1,833.72
| Facility | 50 | $1,833.72 | $1,833.72 | $1,833.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,271.00 / $9,962.39 / $15,740.47
| Facility | | $6,271.00 | $9,962.39 | $15,740.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,545.78 / $2,545.78 / $2,545.78
| Facility | | $2,545.78 | $2,545.78 | $2,545.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $506.73 / $759.44 / $6,840.79
| Facility | | $506.73 | $759.44 | $6,840.79 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $117.43 / $849.00 / $849.00
| Facility | AS | $117.43 | $849.00 | $849.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,157.00 / $4,424.00 / $7,077.94
| Facility | | $1,157.00 | $4,424.00 | $7,077.94 |