- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $936.00 / $3,477.00 / $7,467.00
| Facility | | $936.00 | $3,477.00 | $7,467.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $415.65 / $1,564.80 / $2,559.42
| Facility | | $415.65 | $1,564.80 | $2,559.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $97.04 / $138.69 / $1,887.00
| Facility | | $97.04 | $138.69 | $1,887.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $25.65 / $25.65 / $46.47
| Facility | AS | $25.65 | $25.65 | $46.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $704.00 / $1,535.00 / $2,175.00
| Facility | | $704.00 | $1,535.00 | $2,175.00 |