- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,704.63 / $2,678.00 / $7,602.00
| Facility | | $1,704.63 | $2,678.00 | $7,602.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,375.00 / $2,388.00 / $5,616.00
| Facility | | $1,375.00 | $2,388.00 | $5,616.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $14,314.56 / $14,613.28
| Facility | | $55.00 | $14,314.56 | $14,613.28 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $195.53 / $381.52 / $381.52
| Facility | AS | $195.53 | $381.52 | $381.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,200.00 / $2,665.00 / $4,918.00
| Facility | | $1,200.00 | $2,665.00 | $4,918.00 |