- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,138.48 / $4,500.00 / $8,500.00
| Facility | | $1,138.48 | $4,500.00 | $8,500.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,302.10 / $5,196.00 / $11,433.00
| Facility | | $3,302.10 | $5,196.00 | $11,433.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,184.00 / $1,574.05 / $2,172.58
| Facility | | $1,184.00 | $1,574.05 | $2,172.58 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $92.31 / $92.31 / $92.31
| Facility | AS | $92.31 | $92.31 | $92.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,264.00 / $4,983.00 / $9,202.00
| Facility | | $2,264.00 | $4,983.00 | $9,202.00 |