- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,485.00 / $2,670.00 / $6,235.00
| Facility | | $1,485.00 | $2,670.00 | $6,235.00 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $16,377.98 / $16,377.98 / $16,377.98
| Facility | 50 | $16,377.98 | $16,377.98 | $16,377.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,256.52 / $7,775.00 / $41,339.44
| Facility | | $1,256.52 | $7,775.00 | $41,339.44 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $131.22 / $131.22 / $10,807.58
| Facility | AS | $131.22 | $131.22 | $10,807.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $530.83 / $1,155.88 / $6,679.00
| Facility | | $530.83 | $1,155.88 | $6,679.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,462.71 / $2,462.71 / $2,462.71
| Facility | | $2,462.71 | $2,462.71 | $2,462.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,594.00 / $8,305.00 / $16,394.00
| Facility | | $2,594.00 | $8,305.00 | $16,394.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $131.22 / $131.22 / $10,807.58
| Facility | AS | $131.22 | $131.22 | $10,807.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,594.00 / $7,075.00 / $12,903.00
| Facility | | $2,594.00 | $7,075.00 | $12,903.00 |