- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $625.50 / $2,260.00 / $5,332.00
| Facility | | $625.50 | $2,260.00 | $5,332.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $587.35 / $2,294.12 / $3,616.69
| Facility | | $587.35 | $2,294.12 | $3,616.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $628.73 / $871.81 / $9,251.00
| Facility | | $628.73 | $871.81 | $9,251.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $168.45 / $168.45 / $2,449.69
| Facility | AS | $168.45 | $168.45 | $2,449.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,279.00 / $7,341.00 / $11,396.00
| Facility | | $5,279.00 | $7,341.00 | $11,396.00 |