- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $351.75 / $2,202.00 / $6,915.00
| Facility | | $351.75 | $2,202.00 | $6,915.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,088.00 / $4,247.00 / $9,596.00
| Facility | | $2,088.00 | $4,247.00 | $9,596.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $508.73 / $636.03 / $1,025.89
| Facility | | $508.73 | $636.03 | $1,025.89 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $25.84 / $25.84 / $25.84
| Facility | AS | $25.84 | $25.84 | $25.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $376.00 / $1,221.00 / $2,883.00
| Facility | | $376.00 | $1,221.00 | $2,883.00 |