- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $380.18 / $2,685.76 / $8,008.50
| Facility | | $380.18 | $2,685.76 | $8,008.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,691.00 / $4,247.00 / $8,628.00
| Facility | | $1,691.00 | $4,247.00 | $8,628.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $342.82 / $342.82 / $947.76
| Facility | | $342.82 | $342.82 | $947.76 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $24.31 / $24.31 / $24.31
| Facility | AS | $24.31 | $24.31 | $24.31 |
- 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 |