- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,288.25 / $6,025.60 / $17,782.79
| Facility | | $1,288.25 | $6,025.60 | $17,782.79 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $616.60 / $13,803.84 / $13,803.84
| Facility | AS | $616.60 | $13,803.84 | $13,803.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,265.80 / $12,882.50 / $23,988.33
| Facility | | $4,265.80 | $12,882.50 | $23,988.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,548.82 / $3,311.31 / $14,791.08
| Facility | | $1,548.82 | $3,311.31 | $14,791.08 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $165.96 / $165.96 / $165.96
| Facility | AS | $165.96 | $165.96 | $165.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,019.95 / $8,709.64 / $19,498.45
| Facility | | $3,019.95 | $8,709.64 | $19,498.45 |