- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $898.71 / $3,697.00 / $12,154.00
| Facility | | $898.71 | $3,697.00 | $12,154.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,088.00 / $4,279.00 / $10,043.00
| Facility | | $2,088.00 | $4,279.00 | $10,043.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $701.38 / $1,147.32 / $5,187.00
| Facility | | $701.38 | $1,147.32 | $5,187.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $193.64 / $193.64 / $1,887.52
| Facility | AS | $193.64 | $193.64 | $1,887.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,426.00 / $4,432.00 / $12,989.00
| Facility | | $2,426.00 | $4,432.00 | $12,989.00 |