- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,189.83 / $3,830.00 / $8,646.91
| Facility | | $1,189.83 | $3,830.00 | $8,646.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,450.00 / $11,064.61 / $25,266.70
| Facility | | $4,450.00 | $11,064.61 | $25,266.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $887.50 / $950.00 / $1,096.91
| Facility | | $887.50 | $950.00 | $1,096.91 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $108.71 / $108.71 / $108.71
| Facility | AS | $108.71 | $108.71 | $108.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,912.00 / $6,231.00 / $11,869.99
| Facility | | $2,912.00 | $6,231.00 | $11,869.99 |