- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,107.83 / $3,589.00 / $7,996.00
| Facility | | $1,107.83 | $3,589.00 | $7,996.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,088.00 / $4,247.00 / $9,663.00
| Facility | | $2,088.00 | $4,247.00 | $9,663.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $824.93 / $1,329.56 / $3,532.00
| Facility | | $824.93 | $1,329.56 | $3,532.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $387.54 / $387.54 / $387.54
| Facility | AS | $387.54 | $387.54 | $387.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,644.00 / $2,874.00 / $5,813.00
| Facility | | $1,644.00 | $2,874.00 | $5,813.00 |