- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,591.61 / $4,474.00 / $7,960.15
| Facility | | $1,591.61 | $4,474.00 | $7,960.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,763.75 / $6,640.00 / $10,860.55
| Facility | | $1,763.75 | $6,640.00 | $10,860.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $992.45 / $1,394.16 / $9,251.00
| Facility | | $992.45 | $1,394.16 | $9,251.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $262.95 / $262.95 / $7,575.71
| Facility | AS | $262.95 | $262.95 | $7,575.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,255.00 / $7,205.00 / $11,396.00
| Facility | | $5,255.00 | $7,205.00 | $11,396.00 |