- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,986.14 / $6,591.38 / $11,581.00
| Facility | | $1,986.14 | $6,591.38 | $11,581.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $5,101.42 / $6,288.61 / $7,901.28
| Facility | 50 | $5,101.42 | $6,288.61 | $7,901.28 |
- 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
- $1,157.94 / $1,486.12 / $1,973.75
| Facility | | $1,157.94 | $1,486.12 | $1,973.75 |
- 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
- $1,476.67 / $1,476.67 / $1,476.67
| Facility | | $1,476.67 | $1,476.67 | $1,476.67 |
- 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
- $4,227.00 / $8,448.00 / $13,382.00
| Facility | | $4,227.00 | $8,448.00 | $13,382.00 |