- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $678.50 / $2,011.00 / $7,602.00
| Facility | | $678.50 | $2,011.00 | $7,602.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,767.00 / $5,467.00 / $9,419.00
| Facility | | $1,767.00 | $5,467.00 | $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
- $2,920.10 / $12,000.00 / $19,913.50
| Facility | | $2,920.10 | $12,000.00 | $19,913.50 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $160.83 / $1,887.52 / $1,887.52
| Facility | AS | $160.83 | $1,887.52 | $1,887.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,426.00 / $4,722.00 / $7,669.00
| Facility | | $2,426.00 | $4,722.00 | $7,669.00 |