- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $853.00 / $2,713.50 / $7,856.41
| Facility | | $853.00 | $2,713.50 | $7,856.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,695.00 / $5,486.00 / $9,419.00
| Facility | | $2,695.00 | $5,486.00 | $9,419.00 |
- 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
- $4,198.08 / $26,110.75 / $26,542.00
| Facility | | $4,198.08 | $26,110.75 | $26,542.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $191.63 / $2,474.92 / $2,474.92
| Facility | AS | $191.63 | $2,474.92 | $2,474.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,905.00 / $6,073.00 / $10,287.00
| Facility | | $2,905.00 | $6,073.00 | $10,287.00 |