- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $370.16 / $4,387.00 / $8,524.00
| Facility | | $370.16 | $4,387.00 | $8,524.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $4,251.40 / $4,251.40 / $4,251.40
| Facility | 50 | $4,251.40 | $4,251.40 | $4,251.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,000.00 / $6,557.00 / $11,326.50
| Facility | | $3,000.00 | $6,557.00 | $11,326.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,335.00 / $3,120.00 / $5,441.47
| Facility | | $1,335.00 | $3,120.00 | $5,441.47 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $26.02 / $26.02 / $26.02
| Facility | AS | $26.02 | $26.02 | $26.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $293.00 / $1,264.00 / $3,685.00
| Facility | | $293.00 | $1,264.00 | $3,685.00 |