- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $887.50 / $3,811.00 / $8,066.50
| Facility | | $887.50 | $3,811.00 | $8,066.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,248.00 / $5,196.00 / $11,136.00
| Facility | | $3,248.00 | $5,196.00 | $11,136.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $842.00 / $1,574.05 / $2,070.38
| Facility | | $842.00 | $1,574.05 | $2,070.38 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $73.26 / $73.26 / $73.26
| Facility | AS | $73.26 | $73.26 | $73.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,200.00 / $5,111.00 / $9,202.00
| Facility | | $2,200.00 | $5,111.00 | $9,202.00 |