- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,970.11 / $4,243.50 / $8,572.13
| Facility | | $1,970.11 | $4,243.50 | $8,572.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,450.00 / $11,044.05 / $25,261.30
| Facility | | $4,450.00 | $11,044.05 | $25,261.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $895.00 / $950.00 / $2,125.46
| Facility | | $895.00 | $950.00 | $2,125.46 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $209.94 / $209.94 / $209.94
| Facility | AS | $209.94 | $209.94 | $209.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,738.00 / $5,606.00 / $11,531.00
| Facility | | $1,738.00 | $5,606.00 | $11,531.00 |