- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $796.86 / $2,678.00 / $6,681.00
| Facility | | $796.86 | $2,678.00 | $6,681.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,430.00 / $5,486.00 / $9,272.00
| Facility | | $2,430.00 | $5,486.00 | $9,272.00 |
- 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
- $2,000.00 / $5,127.64 / $5,237.05
| Facility | | $2,000.00 | $5,127.64 | $5,237.05 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $227.46 / $447.27 / $447.27
| Facility | AS | $227.46 | $447.27 | $447.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,905.00 / $6,073.00 / $10,287.00
| Facility | | $2,905.00 | $6,073.00 | $10,287.00 |