- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $676.12 / $3,907.00 / $8,710.00
| Facility | | $676.12 | $3,907.00 | $8,710.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,088.00 / $4,247.00 / $9,663.00
| Facility | | $2,088.00 | $4,247.00 | $9,663.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $476.19 / $1,008.70 / $5,504.00
| Facility | | $476.19 | $1,008.70 | $5,504.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $176.64 / $1,678.13 / $1,678.13
| Facility | AS | $176.64 | $1,678.13 | $1,678.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,156.00 / $4,000.00 / $11,258.00
| Facility | | $2,156.00 | $4,000.00 | $11,258.00 |