- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $741.31 / $3,388.44 / $8,912.51
| Facility | | $741.31 | $3,388.44 | $8,912.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $436.52 / $933.25 / $1,659.59
| Facility | | $436.52 | $933.25 | $1,659.59 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $100.00 / $100.00 / $100.00
| Facility | AS | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,235.94 / $5,888.44 / $11,481.54
| Facility | | $3,235.94 | $5,888.44 | $11,481.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $5,623.41 / $9,772.37
| Facility | | $1,698.24 | $5,623.41 | $9,772.37 |