- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $781.00 / $4,005.00 / $9,311.00
| Facility | | $781.00 | $4,005.00 | $9,311.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $3,022.03 / $3,022.03 / $3,022.03
| Facility | 50 | $3,022.03 | $3,022.03 | $3,022.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,740.00 / $4,120.00 / $8,800.00
| Facility | | $2,740.00 | $4,120.00 | $8,800.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,727.04 / $1,743.57 / $2,283.98
| Facility | | $1,727.04 | $1,743.57 | $2,283.98 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $51.75 / $51.75 / $51.75
| Facility | AS | $51.75 | $51.75 | $51.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,198.00 / $4,706.00 / $7,254.50
| Facility | | $2,198.00 | $4,706.00 | $7,254.50 |