- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,012.18 / $6,024.00 / $12,669.00
| Facility | | $1,012.18 | $6,024.00 | $12,669.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $400.00 / $500.00 / $3,436.74
| Facility | | $400.00 | $500.00 | $3,436.74 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $126.27 / $126.27 / $126.27
| Facility | AS | $126.27 | $126.27 | $126.27 |
- 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
- $573.00 / $4,414.00 / $9,150.00
| Facility | | $573.00 | $4,414.00 | $9,150.00 |