- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $989.44 / $5,350.41 / $10,083.52
| Facility | | $989.44 | $5,350.41 | $10,083.52 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $8,703.00 / $9,084.00 / $11,211.76
| Facility | 50 | $8,703.00 | $9,084.00 | $11,211.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,307.00 / $6,001.00 / $11,446.00
| Facility | | $3,307.00 | $6,001.00 | $11,446.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $971.50 / $1,735.53 / $3,258.41
| Facility | | $971.50 | $1,735.53 | $3,258.41 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $71.36 / $71.36 / $71.36
| Facility | AS | $71.36 | $71.36 | $71.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,788.00 / $4,749.26 / $9,894.29
| Facility | | $1,788.00 | $4,749.26 | $9,894.29 |