- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $719.21 / $3,434.00 / $7,996.00
| Facility | | $719.21 | $3,434.00 | $7,996.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,088.00 / $4,247.00 / $9,663.00
| Facility | | $2,088.00 | $4,247.00 | $9,663.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $568.63 / $926.00 / $19,067.25
| Facility | | $568.63 | $926.00 | $19,067.25 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $157.18 / $157.18 / $1,887.52
| Facility | AS | $157.18 | $157.18 | $1,887.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,748.00 / $3,502.00 / $6,854.00
| Facility | | $1,748.00 | $3,502.00 | $6,854.00 |