- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,965.00 / $4,521.00 / $7,963.00
| Facility | | $1,965.00 | $4,521.00 | $7,963.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,763.75 / $6,640.00 / $10,860.55
| Facility | | $1,763.75 | $6,640.00 | $10,860.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,177.65 / $1,583.41 / $7,140.00
| Facility | | $1,177.65 | $1,583.41 | $7,140.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $311.20 / $311.20 / $565.11
| Facility | AS | $311.20 | $311.20 | $565.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,637.00 / $6,477.00 / $9,010.00
| Facility | | $4,637.00 | $6,477.00 | $9,010.00 |