- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $516.11 / $2,258.00 / $7,119.04
| Facility | | $516.11 | $2,258.00 | $7,119.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,500.00 / $7,007.00 / $13,545.50
| Facility | | $2,500.00 | $7,007.00 | $13,545.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $507.00 / $507.00 / $641.21
| Facility | | $507.00 | $507.00 | $641.21 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $37.13 / $37.13 / $37.13
| Facility | AS | $37.13 | $37.13 | $37.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $293.00 / $1,218.00 / $2,733.00
| Facility | | $293.00 | $1,218.00 | $2,733.00 |