- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $735.05 / $735.05 / $2,525.00
| Facility | | $735.05 | $735.05 | $2,525.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,509.28 / $4,306.26 / $7,808.13
| Facility | | $2,509.28 | $4,306.26 | $7,808.13 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $4,402.57 / $6,679.66 / $11,712.19
| Facility | 50 | $4,402.57 | $6,679.66 | $11,712.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,830.98 / $2,597.90 / $6,249.59
| Facility | | $1,830.98 | $2,597.90 | $6,249.59 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $86.57 / $86.57 / $86.57
| Facility | AS | $86.57 | $86.57 | $86.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,664.53 / $2,375.10 / $4,920.93
| Facility | | $1,664.53 | $2,375.10 | $4,920.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $760.34 / $1,294.43 / $3,312.00
| Facility | | $760.34 | $1,294.43 | $3,312.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $194.51 / $194.51 / $194.51
| Facility | AS | $194.51 | $194.51 | $194.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,412.00 / $5,058.83 / $8,812.00
| Facility | | $2,412.00 | $5,058.83 | $8,812.00 |