- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,648.50 / $3,889.00 / $6,820.00
| Facility | | $1,648.50 | $3,889.00 | $6,820.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $830.45 / $3,377.49 / $5,113.62
| Facility | | $830.45 | $3,377.49 | $5,113.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $973.21 / $1,400.00 / $9,251.00
| Facility | | $973.21 | $1,400.00 | $9,251.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $259.20 / $259.20 / $1,887.52
| Facility | AS | $259.20 | $259.20 | $1,887.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,364.00 / $7,457.00 / $11,396.00
| Facility | | $5,364.00 | $7,457.00 | $11,396.00 |