- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,316.37 / $1,316.37 / $6,781.00
| Facility | | $1,316.37 | $1,316.37 | $6,781.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,088.76 / $5,302.71 / $10,792.37
| Facility | | $2,088.76 | $5,302.71 | $10,792.37 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $3,664.75 / $5,560.23 / $9,749.37
| Facility | 50 | $3,664.75 | $5,560.23 | $9,749.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,194.74 / $4,532.88 / $10,904.46
| Facility | | $3,194.74 | $4,532.88 | $10,904.46 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $150.40 / $150.40 / $150.40
| Facility | AS | $150.40 | $150.40 | $150.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,904.31 / $4,144.14 / $8,586.19
| Facility | | $2,904.31 | $4,144.14 | $8,586.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,362.75 / $2,250.00 / $3,872.43
| Facility | | $1,362.75 | $2,250.00 | $3,872.43 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $339.92 / $339.92 / $339.92
| Facility | AS | $339.92 | $339.92 | $339.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,940.00 / $7,872.00 / $11,531.00
| Facility | | $3,940.00 | $7,872.00 | $11,531.00 |