- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $733.85 / $2,678.00 / $7,602.00
| Facility | | $733.85 | $2,678.00 | $7,602.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,309.00 / $5,486.00 / $9,283.00
| Facility | | $2,309.00 | $5,486.00 | $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 / $6,946.28 / $7,090.16
| Facility | | $55.00 | $6,946.28 | $7,090.16 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $139.51 / $276.32 / $276.32
| Facility | AS | $139.51 | $276.32 | $276.32 |
- 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 |