- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $5,723.00 / $12,173.00
| Facility | | $1,000.00 | $5,723.00 | $12,173.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $1,612.33 / $5,881.67 / $16,626.90
| Facility | 50 | $1,612.33 | $5,881.67 | $16,626.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $670.45 / $1,679.72 / $6,644.00
| Facility | | $670.45 | $1,679.72 | $6,644.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $66.25 / $66.25 / $66.25
| Facility | AS | $66.25 | $66.25 | $66.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,672.00 / $12,190.00 / $22,833.00
| Facility | | $4,672.00 | $12,190.00 | $22,833.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,788.00 / $7,558.00 / $12,040.00
| Facility | | $1,788.00 | $7,558.00 | $12,040.00 |