- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $2,331.21 / $9,859.00
| Facility | | $100.00 | $2,331.21 | $9,859.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,497.60 / $36,315.22 / $63,311.75
| Facility | | $1,497.60 | $36,315.22 | $63,311.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $840.68 / $840.68 / $840.68
| Facility | | $840.68 | $840.68 | $840.68 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $83.44 / $83.44 / $83.44
| Facility | AS | $83.44 | $83.44 | $83.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,399.00 / $12,399.00 / $12,399.00
| Facility | | $12,399.00 | $12,399.00 | $12,399.00 |