- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,424.64 / $7,986.00 / $22,384.00
| Facility | | $2,424.64 | $7,986.00 | $22,384.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $7,901.28 / $10,965.00 / $14,756.86
| Facility | 50 | $7,901.28 | $10,965.00 | $14,756.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,670.00 / $6,746.00 / $30,285.00
| Facility | | $2,670.00 | $6,746.00 | $30,285.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $876.60 / $1,051.92 / $1,314.90
| Facility | | $876.60 | $1,051.92 | $1,314.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,571.00 / $21,571.00 / $21,571.00
| Facility | | $21,571.00 | $21,571.00 | $21,571.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,041.04 / $6,958.53 / $14,701.46
| Facility | | $3,041.04 | $6,958.53 | $14,701.46 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $103.83 / $103.83 / $103.83
| Facility | AS | $103.83 | $103.83 | $103.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,227.00 / $8,448.00 / $13,382.00
| Facility | | $4,227.00 | $8,448.00 | $13,382.00 |