- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $936.22 / $3,008.50 / $7,325.50
| Facility | | $936.22 | $3,008.50 | $7,325.50 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $9,621.00 / $9,621.00 / $9,621.00
| Facility | 50 | $9,621.00 | $9,621.00 | $9,621.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.00 / $4,133.00 / $8,240.00
| Facility | | $2,137.00 | $4,133.00 | $8,240.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $871.56 / $956.86 / $1,272.50
| Facility | | $871.56 | $956.86 | $1,272.50 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $86.57 / $86.57 / $86.57
| Facility | AS | $86.57 | $86.57 | $86.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,954.00 / $4,223.00 / $7,355.00
| Facility | | $1,954.00 | $4,223.00 | $7,355.00 |