- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $884.26 / $3,901.00 / $9,867.50
| Facility | | $884.26 | $3,901.00 | $9,867.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,302.10 / $6,395.00 / $13,523.26
| Facility | | $3,302.10 | $6,395.00 | $13,523.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $917.33 / $1,809.80 / $2,563.87
| Facility | | $917.33 | $1,809.80 | $2,563.87 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $70.31 / $70.31 / $70.31
| Facility | AS | $70.31 | $70.31 | $70.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,200.00 / $5,111.00 / $9,622.00
| Facility | | $2,200.00 | $5,111.00 | $9,622.00 |