- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,628.31 / $5,757.00 / $12,332.18
| Facility | | $1,628.31 | $5,757.00 | $12,332.18 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $7,424.47 / $9,774.85 / $9,774.85
| Facility | 50 | $7,424.47 | $9,774.85 | $9,774.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,989.00 / $9,720.00 / $17,206.00
| Facility | | $4,989.00 | $9,720.00 | $17,206.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,769.12 / $5,034.57 / $6,221.63
| Facility | | $4,769.12 | $5,034.57 | $6,221.63 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $124.67 / $124.67 / $124.67
| Facility | AS | $124.67 | $124.67 | $124.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,059.00 / $6,527.50 / $12,055.49
| Facility | | $3,059.00 | $6,527.50 | $12,055.49 |