- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,040.66 / $4,247.55 / $10,519.38
| Facility | | $1,040.66 | $4,247.55 | $10,519.38 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $1,542.15 / $3,882.80 / $11,891.99
| Facility | 50 | $1,542.15 | $3,882.80 | $11,891.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,695.00 / $5,467.00 / $9,272.00
| Facility | | $2,695.00 | $5,467.00 | $9,272.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,230.31 / $16,223.75 / $26,542.00
| Facility | | $4,230.31 | $16,223.75 | $26,542.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $165.08 / $1,537.78 / $1,537.78
| Facility | AS | $165.08 | $1,537.78 | $1,537.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,964.00 / $8,273.00 / $12,407.00
| Facility | | $3,964.00 | $8,273.00 | $12,407.00 |