- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,400.00 / $2,222.66 / $14,451.40
| Facility | | $1,400.00 | $2,222.66 | $14,451.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,536.86 / $1,721.28 / $1,875.37
| Facility | | $1,536.86 | $1,721.28 | $1,875.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,642.08 / $1,642.08 / $1,642.08
| Facility | | $1,642.08 | $1,642.08 | $1,642.08 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $162.59 / $162.59 / $162.59
| Facility | AS | $162.59 | $162.59 | $162.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $51,559.53 / $51,559.53 / $51,559.53
| Facility | | $51,559.53 | $51,559.53 | $51,559.53 |