- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,014.00 / $3,777.00 / $9,872.00
| Facility | | $2,014.00 | $3,777.00 | $9,872.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $3,862.50 / $3,862.50 / $3,862.50
| Facility | 50 | $3,862.50 | $3,862.50 | $3,862.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,999.00 / $26,120.00 / $67,429.00
| Facility | | $15,999.00 | $26,120.00 | $67,429.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,737.54 / $21,737.54 / $50,000.00
| Facility | | $21,737.54 | $21,737.54 | $50,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $796.47 / $965.32 / $1,367.53
| Facility | | $796.47 | $965.32 | $1,367.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $876.12 / $1,194.71 / $1,592.94
| Professional | | $876.12 | $1,194.71 | $1,592.94 |
- Facility/Professional
- Professional
- Modifier
- AS
- Low / Median / High Price
- $21.66 / $21.66 / $21.66
| Professional | AS | $21.66 | $21.66 | $21.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,858.00 / $20,006.00 / $30,333.00
| Facility | | $12,858.00 | $20,006.00 | $30,333.00 |