- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,040.78 / $2,678.00 / $7,602.00
| Facility | | $1,040.78 | $2,678.00 | $7,602.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,439.00 / $5,486.00 / $9,283.00
| Facility | | $2,439.00 | $5,486.00 | $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
- $3,095.08 / $25,442.40 / $26,542.00
| Facility | | $3,095.08 | $25,442.40 | $26,542.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $214.60 / $2,411.58 / $2,411.58
| Facility | AS | $214.60 | $2,411.58 | $2,411.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,964.00 / $8,273.00 / $12,407.00
| Facility | | $3,964.00 | $8,273.00 | $12,407.00 |