- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $694.40 / $4,785.00 / $9,526.85
| Facility | | $694.40 | $4,785.00 | $9,526.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,486.00 / $4,343.00 / $10,957.00
| Facility | | $2,486.00 | $4,343.00 | $10,957.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $440.76 / $817.12 / $3,177.11
| Facility | | $440.76 | $817.12 | $3,177.11 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $43.36 / $43.36 / $43.36
| Facility | AS | $43.36 | $43.36 | $43.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,413.00 / $5,632.00 / $12,349.00
| Facility | | $2,413.00 | $5,632.00 | $12,349.00 |