- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,256.00 / $4,060.18 / $6,681.00
| Facility | | $1,256.00 | $4,060.18 | $6,681.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,984.00 / $5,486.00 / $9,283.00
| Facility | | $2,984.00 | $5,486.00 | $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
- $3,126.60 / $26,542.00 / $27,023.05
| Facility | | $3,126.60 | $26,542.00 | $27,023.05 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $214.46 / $2,561.40 / $2,561.40
| Facility | AS | $214.46 | $2,561.40 | $2,561.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,098.00 / $8,273.00 / $12,407.00
| Facility | | $4,098.00 | $8,273.00 | $12,407.00 |