- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,346.00 / $4,928.00 / $16,400.00
| Facility | | $1,346.00 | $4,928.00 | $16,400.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $900.00 / $900.00 / $900.00
| Facility | | $900.00 | $900.00 | $900.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,102.75 / $2,959.64 / $18,958.34
| Facility | | $2,102.75 | $2,959.64 | $18,958.34 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $520.80 / $967.18 / $967.18
| Facility | AS | $520.80 | $967.18 | $967.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,228.00 / $10,642.00 / $20,423.23
| Facility | | $3,228.00 | $10,642.00 | $20,423.23 |