- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,128.75 / $3,819.00 / $6,820.00
| Facility | | $1,128.75 | $3,819.00 | $6,820.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $830.45 / $3,126.40 / $5,113.62
| Facility | | $830.45 | $3,126.40 | $5,113.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $906.63 / $1,230.00 / $9,251.00
| Facility | | $906.63 | $1,230.00 | $9,251.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $242.52 / $242.52 / $5,213.89
| Facility | AS | $242.52 | $242.52 | $5,213.89 |
- 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 |