- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,582.65 / $5,715.00 / $11,581.00
| Facility | | $1,582.65 | $5,715.00 | $11,581.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $7,478.77 / $8,773.50 / $9,327.00
| Facility | 50 | $7,478.77 | $8,773.50 | $9,327.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,996.00 / $9,644.00 / $18,544.00
| Facility | | $6,996.00 | $9,644.00 | $18,544.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,211.00 / $3,851.90 / $5,770.12
| Facility | | $2,211.00 | $3,851.90 | $5,770.12 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $146.47 / $146.47 / $146.47
| Facility | AS | $146.47 | $146.47 | $146.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,028.00 / $7,499.00 / $14,242.22
| Facility | | $3,028.00 | $7,499.00 | $14,242.22 |