- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,245.01 / $2,678.00 / $6,681.00
| Facility | | $1,245.01 | $2,678.00 | $6,681.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,367.00 / $5,467.00 / $9,283.00
| Facility | | $2,367.00 | $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
- $3,668.84 / $25,650.30 / $26,542.00
| Facility | | $3,668.84 | $25,650.30 | $26,542.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $251.87 / $2,431.29 / $2,431.29
| Facility | AS | $251.87 | $2,431.29 | $2,431.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,238.00 / $7,695.00 / $12,782.00
| Facility | | $4,238.00 | $7,695.00 | $12,782.00 |