- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $731.49 / $3,508.50 / $8,174.95
| Facility | | $731.49 | $3,508.50 | $8,174.95 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $2,193.66 / $3,124.00 / $6,535.09
| Facility | 50 | $2,193.66 | $3,124.00 | $6,535.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,302.10 / $5,944.00 / $11,253.00
| Facility | | $3,302.10 | $5,944.00 | $11,253.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,618.26 / $1,618.26 / $2,061.25
| Facility | | $1,618.26 | $1,618.26 | $2,061.25 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $50.41 / $50.41 / $50.41
| Facility | AS | $50.41 | $50.41 | $50.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,637.00 / $5,735.00 / $9,622.00
| Facility | | $2,637.00 | $5,735.00 | $9,622.00 |