- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,346.00 / $6,187.00 / $17,442.08
| Facility | | $1,346.00 | $6,187.00 | $17,442.08 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $7,987.51 / $10,422.00 / $17,791.37
| Facility | 50 | $7,987.51 | $10,422.00 | $17,791.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,813.00 / $12,220.00 / $19,065.61
| Facility | | $7,813.00 | $12,220.00 | $19,065.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,321.00 / $2,321.00 / $2,321.00
| Facility | | $2,321.00 | $2,321.00 | $2,321.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $574.35 / $786.89 / $10,617.00
| Facility | | $574.35 | $786.89 | $10,617.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $1,537.78 / $1,537.78 / $1,537.78
| Facility | AS | $1,537.78 | $1,537.78 | $1,537.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,851.00 / $6,871.00 / $14,139.00
| Facility | | $1,851.00 | $6,871.00 | $14,139.00 |