- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $752.01 / $752.01 / $6,575.00
| Facility | | $752.01 | $752.01 | $6,575.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,490.86 / $12,197.67 / $25,424.06
| Facility | | $3,490.86 | $12,197.67 | $25,424.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,829.30 / $2,595.51 / $6,243.84
| Facility | | $1,829.30 | $2,595.51 | $6,243.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,663.00 / $2,372.92 / $4,916.41
| Facility | | $1,663.00 | $2,372.92 | $4,916.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $792.56 / $1,311.19 / $3,293.00
| Facility | | $792.56 | $1,311.19 | $3,293.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $194.04 / $194.04 / $194.04
| Facility | AS | $194.04 | $194.04 | $194.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,121.00 / $5,499.00 / $9,810.00
| Facility | | $3,121.00 | $5,499.00 | $9,810.00 |