- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,386.23 / $5,946.00 / $14,100.00
| Facility | | $1,386.23 | $5,946.00 | $14,100.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $7,636.43 / $7,636.43 / $7,636.43
| Facility | 50 | $7,636.43 | $7,636.43 | $7,636.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,444.76 / $15,084.81 / $23,838.74
| Facility | | $9,444.76 | $15,084.81 | $23,838.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,659.86 / $5,792.00 / $5,792.00
| Facility | | $5,659.86 | $5,792.00 | $5,792.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $869.05 / $1,386.24 / $13,541.98
| Facility | | $869.05 | $1,386.24 | $13,541.98 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $227.67 / $1,887.52 / $1,887.52
| Facility | AS | $227.67 | $1,887.52 | $1,887.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,851.00 / $8,072.00 / $14,139.00
| Facility | | $1,851.00 | $8,072.00 | $14,139.00 |