- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $528.41 / $2,258.00 / $7,602.00
| Facility | | $528.41 | $2,258.00 | $7,602.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $108.00 / $147.00 / $2,430.00
| Facility | | $108.00 | $147.00 | $2,430.00 |
- 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
- $668.96 / $2,000.00 / $2,000.00
| Facility | | $668.96 | $2,000.00 | $2,000.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $66.90 / $132.77 / $132.77
| Facility | AS | $66.90 | $132.77 | $132.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $294.00 / $808.00 / $2,577.00
| Facility | | $294.00 | $808.00 | $2,577.00 |