- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $364.50 / $2,593.50 / $7,431.00
| Facility | | $364.50 | $2,593.50 | $7,431.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $10,233.70 / $10,233.70 / $10,233.70
| Facility | 50 | $10,233.70 | $10,233.70 | $10,233.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,456.00 / $7,875.00 / $10,043.00
| Facility | | $2,456.00 | $7,875.00 | $10,043.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $267.83 / $323.00 / $540.12
| Facility | | $267.83 | $323.00 | $540.12 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $83.65 / $83.65 / $83.65
| Facility | 62 | $83.65 | $83.65 | $83.65 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $13.38 / $13.38 / $13.38
| Facility | AS | $13.38 | $13.38 | $13.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $410.00 / $1,202.00 / $2,947.00
| Facility | | $410.00 | $1,202.00 | $2,947.00 |