- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $627.30 / $5,014.35 / $9,952.46
| Facility | | $627.30 | $5,014.35 | $9,952.46 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $2,598.36 / $7,232.86 / $14,635.98
| Facility | 50 | $2,598.36 | $7,232.86 | $14,635.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,320.00 / $4,926.00 / $11,758.00
| Facility | | $2,320.00 | $4,926.00 | $11,758.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $604.80 / $846.73 / $997.94
| Facility | | $604.80 | $846.73 | $997.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $718.46 / $746.90 / $746.90
| Facility | | $718.46 | $746.90 | $746.90 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $73.26 / $73.26 / $73.26
| Facility | AS | $73.26 | $73.26 | $73.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $973.00 / $4,639.00 / $12,296.00
| Facility | | $973.00 | $4,639.00 | $12,296.00 |