- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $706.44 / $3,279.31 / $7,572.00
| Facility | | $706.44 | $3,279.31 | $7,572.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,329.05 / $4,688.67 / $8,005.03
| Facility | | $2,329.05 | $4,688.67 | $8,005.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $759.29 / $759.29 / $1,439.27
| Facility | | $759.29 | $759.29 | $1,439.27 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $45.63 / $45.63 / $45.63
| Facility | AS | $45.63 | $45.63 | $45.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,403.00 / $3,325.00 / $8,152.00
| Facility | | $1,403.00 | $3,325.00 | $8,152.00 |