- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $429.31 / $2,678.00 / $7,602.00
| Facility | | $429.31 | $2,678.00 | $7,602.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $108.00 / $148.00 / $2,895.00
| Facility | | $108.00 | $148.00 | $2,895.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $1,300.00 / $1,300.00
| Facility | | $55.00 | $1,300.00 | $1,300.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $50.90 / $102.75 / $102.75
| Facility | AS | $50.90 | $102.75 | $102.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,200.00 / $2,665.00 / $4,918.00
| Facility | | $1,200.00 | $2,665.00 | $4,918.00 |