- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,671.00 / $6,126.00 / $15,822.76
| Facility | | $1,671.00 | $6,126.00 | $15,822.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,827.50 / $7,671.20 / $12,233.50
| Facility | | $1,827.50 | $7,671.20 | $12,233.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $923.65 / $1,226.94 / $9,251.00
| Facility | | $923.65 | $1,226.94 | $9,251.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $246.06 / $246.06 / $7,997.44
| Facility | AS | $246.06 | $246.06 | $7,997.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,255.00 / $7,341.00 / $13,500.00
| Facility | | $5,255.00 | $7,341.00 | $13,500.00 |