- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.03 / $3,235.94 / $9,549.93
| Facility | | $537.03 | $3,235.94 | $9,549.93 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $3,715.35 / $10,232.93 / $17,782.79
| Facility | 50 | $3,715.35 | $10,232.93 | $17,782.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,073.80 / $10,000.00 / $17,782.79
| Facility | | $4,073.80 | $10,000.00 | $17,782.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.67 / $346.74 / $954.99
| Facility | | $34.67 | $346.74 | $954.99 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $128.82 / $128.82 / $128.82
| Facility | 62 | $128.82 | $128.82 | $128.82 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $20.89 / $20.89 / $20.89
| Facility | AS | $20.89 | $20.89 | $20.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $295.12 / $1,202.26 / $3,715.35
| Facility | | $295.12 | $1,202.26 | $3,715.35 |