- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,170.00 / $2,640.00 / $5,506.00
| Facility | | $1,170.00 | $2,640.00 | $5,506.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $903.06 / $3,321.60 / $5,432.89
| Facility | | $903.06 | $3,321.60 | $5,432.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $272.97 / $486.37 / $1,944.00
| Facility | | $272.97 | $486.37 | $1,944.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $63.74 / $63.74 / $119.44
| Facility | AS | $63.74 | $63.74 | $119.44 |
- 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 |