- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $479.21 / $1,621.78 / $7,993.00
| Facility | | $479.21 | $1,621.78 | $7,993.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $606.10 / $606.10 / $6,025.59
| Facility | | $606.10 | $606.10 | $6,025.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $488.38 / $805.59 / $1,213.50
| Facility | | $488.38 | $805.59 | $1,213.50 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $88.90 / $151.62 / $179.22
| Facility | AS | $88.90 | $151.62 | $179.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,015.00 / $15,545.00 / $22,780.00
| Facility | | $4,015.00 | $15,545.00 | $22,780.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,245.88 / $2,454.98 / $26,542.00
| Facility | | $2,245.88 | $2,454.98 | $26,542.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $127.09 / $245.50 / $245.50
| Facility | AS | $127.09 | $245.50 | $245.50 |