- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $767.36 / $6,024.00 / $11,624.00
| Facility | | $767.36 | $6,024.00 | $11,624.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $400.00 / $500.00 / $2,566.26
| Facility | | $400.00 | $500.00 | $2,566.26 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $95.41 / $95.41 / $95.41
| Facility | AS | $95.41 | $95.41 | $95.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,281.00 / $20,730.00 / $31,914.00
| Facility | | $6,281.00 | $20,730.00 | $31,914.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,301.00 / $5,675.00 / $9,772.00
| Facility | | $1,301.00 | $5,675.00 | $9,772.00 |