- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,100.00 / $4,840.00 / $8,563.93
| Facility | | $2,100.00 | $4,840.00 | $8,563.93 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $2,688.75 / $4,567.50 / $8,436.00
| Facility | 50 | $2,688.75 | $4,567.50 | $8,436.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,341.54 / $5,330.69 / $8,070.83
| Facility | | $1,341.54 | $5,330.69 | $8,070.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $879.59 / $1,219.65 / $9,153.00
| Facility | | $879.59 | $1,219.65 | $9,153.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $227.67 / $227.67 / $1,887.52
| Facility | AS | $227.67 | $227.67 | $1,887.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,279.00 / $7,499.00 / $11,396.00
| Facility | | $5,279.00 | $7,499.00 | $11,396.00 |