- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,380.38 / $5,754.40 / $14,454.40
| Facility | | $1,380.38 | $5,754.40 | $14,454.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,073.80 / $12,589.25 / $23,988.33
| Facility | | $4,073.80 | $12,589.25 | $23,988.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,659.59 / $3,090.30 / $8,317.64
| Facility | | $1,659.59 | $3,090.30 | $8,317.64 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $165.96 / $165.96 / $165.96
| Facility | AS | $165.96 | $165.96 | $165.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $7,244.36 / $16,982.44
| Facility | | $2,454.71 | $7,244.36 | $16,982.44 |