- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,256.00 / $3,112.66 / $7,602.00
| Facility | | $1,256.00 | $3,112.66 | $7,602.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,695.00 / $5,467.00 / $9,283.00
| Facility | | $2,695.00 | $5,467.00 | $9,283.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30.00 / $30.00 / $30.00
| Facility | | $30.00 | $30.00 | $30.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $9,462.32 / $9,671.76
| Facility | | $55.00 | $9,462.32 | $9,671.76 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $300.10 / $591.36 / $591.36
| Facility | AS | $300.10 | $591.36 | $591.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,964.00 / $8,273.00 / $12,407.00
| Facility | | $3,964.00 | $8,273.00 | $12,407.00 |