- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $813.00 / $3,221.00 / $10,652.02
| Facility | | $813.00 | $3,221.00 | $10,652.02 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $13,828.68 / $15,602.56 / $15,602.56
| Facility | 50 | $13,828.68 | $15,602.56 | $15,602.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,774.03 / $6,327.46 / $13,197.70
| Facility | | $2,774.03 | $6,327.46 | $13,197.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $914.00 / $1,434.00 / $10,962.00
| Facility | | $914.00 | $1,434.00 | $10,962.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $71.36 / $71.36 / $71.36
| Facility | AS | $71.36 | $71.36 | $71.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $697.50 / $1,077.95 / $2,758.01
| Professional | | $697.50 | $1,077.95 | $2,758.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $100.00 / $100.00
| Facility | | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,172.00 / $5,000.00 / $8,995.00
| Facility | | $1,172.00 | $5,000.00 | $8,995.00 |