- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,148.36 / $4,192.00 / $9,592.01
| Facility | | $1,148.36 | $4,192.00 | $9,592.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,977.00 / $9,219.00 / $17,420.00
| Facility | | $4,977.00 | $9,219.00 | $17,420.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,040.00 / $2,472.40 / $9,364.93
| Facility | | $1,040.00 | $2,472.40 | $9,364.93 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $101.30 / $101.30 / $101.30
| Facility | AS | $101.30 | $101.30 | $101.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,028.00 / $7,457.00 / $14,139.00
| Facility | | $3,028.00 | $7,457.00 | $14,139.00 |