- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $621.86 / $3,325.00 / $10,635.00
| Facility | | $621.86 | $3,325.00 | $10,635.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,969.00 / $9,153.00 / $60,320.00
| Facility | | $2,969.00 | $9,153.00 | $60,320.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $379.85 / $414.38 / $603.39
| Facility | | $379.85 | $414.38 | $603.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,571.00 / $21,571.00 / $21,571.00
| Facility | | $21,571.00 | $21,571.00 | $21,571.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $491.30 / $491.30 / $491.30
| Facility | | $491.30 | $491.30 | $491.30 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $48.50 / $48.50 / $48.50
| Facility | AS | $48.50 | $48.50 | $48.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,070.00 / $8,440.00 / $13,382.00
| Facility | | $4,070.00 | $8,440.00 | $13,382.00 |