- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $987.46 / $5,784.00 / $11,536.06
| Facility | | $987.46 | $5,784.00 | $11,536.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,760.00 / $3,967.00 / $14,996.00
| Facility | | $1,760.00 | $3,967.00 | $14,996.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $762.32 / $914.78 / $1,143.48
| Facility | | $762.32 | $914.78 | $1,143.48 |
- 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
- $944.77 / $1,985.84 / $6,044.91
| Facility | | $944.77 | $1,985.84 | $6,044.91 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $94.40 / $94.40 / $94.40
| Facility | AS | $94.40 | $94.40 | $94.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,206.00 / $6,231.00 / $10,075.00
| Facility | | $3,206.00 | $6,231.00 | $10,075.00 |