- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $877.78 / $2,678.00 / $6,681.00
| Facility | | $877.78 | $2,678.00 | $6,681.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,430.00 / $5,467.00 / $9,283.00
| Facility | | $2,430.00 | $5,467.00 | $9,283.00 |
- 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
- $2,537.04 / $25,341.00 / $26,542.00
| Facility | | $2,537.04 | $25,341.00 | $26,542.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $174.07 / $2,401.96 / $2,401.96
| Facility | AS | $174.07 | $2,401.96 | $2,401.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,964.00 / $8,273.00 / $12,407.00
| Facility | | $3,964.00 | $8,273.00 | $12,407.00 |