- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $405.21 / $2,284.80 / $9,062.00
| Facility | | $405.21 | $2,284.80 | $9,062.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,010.26 / $4,952.66 / $8,588.78
| Facility | | $2,010.26 | $4,952.66 | $8,588.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $505.00 / $608.79 / $2,581.96
| Facility | | $505.00 | $608.79 | $2,581.96 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $60.88 / $60.88 / $60.88
| Facility | AS | $60.88 | $60.88 | $60.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $405.21 / $600.04 / $971.83
| Facility | | $405.21 | $600.04 | $971.83 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $74.48 / $93.10 / $136.06
| Facility | AS | $74.48 | $93.10 | $136.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,550.00 / $10,257.00 / $16,249.00
| Facility | | $1,550.00 | $10,257.00 | $16,249.00 |