- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,541.48 / $4,182.00 / $6,820.00
| Facility | | $1,541.48 | $4,182.00 | $6,820.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $2,472.75 / $4,945.50 / $10,298.75
| Facility | 50 | $2,472.75 | $4,945.50 | $10,298.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $830.45 / $3,228.01 / $5,113.62
| Facility | | $830.45 | $3,228.01 | $5,113.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,941.68 / $4,941.68 / $4,941.68
| Facility | | $4,941.68 | $4,941.68 | $4,941.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $759.35 / $1,028.90 / $6,117.00
| Facility | | $759.35 | $1,028.90 | $6,117.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $202.10 / $1,442.13 / $1,442.13
| Facility | AS | $202.10 | $1,442.13 | $1,442.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,912.00 / $4,545.00 / $7,217.00
| Facility | | $2,912.00 | $4,545.00 | $7,217.00 |