- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,407.34 / $2,950.00 / $7,602.00
| Facility | | $1,407.34 | $2,950.00 | $7,602.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,430.00 / $7,133.00 / $13,623.00
| Facility | | $2,430.00 | $7,133.00 | $13,623.00 |
- 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
- $4,182.84 / $26,542.00 / $49,680.10
| Facility | | $4,182.84 | $26,542.00 | $49,680.10 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $286.66 / $4,708.97 / $4,708.97
| Facility | AS | $286.66 | $4,708.97 | $4,708.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,098.00 / $8,273.00 / $12,407.00
| Facility | | $4,098.00 | $8,273.00 | $12,407.00 |