- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $476.11 / $3,487.00 / $9,035.00
| Facility | | $476.11 | $3,487.00 | $9,035.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,749.00 / $9,219.00 / $17,206.00
| Facility | | $4,749.00 | $9,219.00 | $17,206.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $748.70 / $1,075.31 / $3,693.93
| Facility | | $748.70 | $1,075.31 | $3,693.93 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $30.65 / $30.65 / $30.65
| Facility | AS | $30.65 | $30.65 | $30.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,200.00 / $5,111.00 / $9,202.00
| Facility | | $2,200.00 | $5,111.00 | $9,202.00 |