- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $342.00 / $3,714.00 / $9,925.10
| Facility | | $342.00 | $3,714.00 | $9,925.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $98.36 / $103.54 / $120.82
| Facility | | $98.36 | $103.54 | $120.82 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $11.78 / $11.78 / $11.78
| Facility | AS | $11.78 | $11.78 | $11.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,752.00 / $2,894.00 / $6,108.00
| Facility | | $1,752.00 | $2,894.00 | $6,108.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $351.00 / $1,916.00 / $4,970.00
| Facility | | $351.00 | $1,916.00 | $4,970.00 |