- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,347.81 / $4,827.50 / $10,708.50
| Facility | | $1,347.81 | $4,827.50 | $10,708.50 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $3,761.71 / $3,761.71 / $3,761.71
| Facility | 50 | $3,761.71 | $3,761.71 | $3,761.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,093.00 / $10,099.00 / $17,774.00
| Facility | | $6,093.00 | $10,099.00 | $17,774.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,211.00 / $3,851.90 / $5,792.00
| Facility | | $2,211.00 | $3,851.90 | $5,792.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $124.52 / $124.52 / $124.52
| Facility | AS | $124.52 | $124.52 | $124.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,028.00 / $7,576.00 / $14,242.22
| Facility | | $3,028.00 | $7,576.00 | $14,242.22 |