- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $66.06 / $1,821.00 / $6,827.70
| Facility | | $66.06 | $1,821.00 | $6,827.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $937.00 / $1,963.00 / $4,348.00
| Facility | | $937.00 | $1,963.00 | $4,348.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $250.71 / $279.75 / $596.46
| Facility | | $250.71 | $279.75 | $596.46 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $7.56 / $7.56 / $7.56
| Facility | AS | $7.56 | $7.56 | $7.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $363.50 / $1,189.50 / $2,808.00
| Facility | | $363.50 | $1,189.50 | $2,808.00 |