- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $637.18 / $3,931.00 / $8,181.00
| Facility | | $637.18 | $3,931.00 | $8,181.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,432.00 / $7,578.00 / $15,328.00
| Facility | | $4,432.00 | $7,578.00 | $15,328.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $550.00 / $550.00 / $1,394.47
| Facility | | $550.00 | $550.00 | $1,394.47 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $33.82 / $33.82 / $33.82
| Facility | AS | $33.82 | $33.82 | $33.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,206.00 / $6,578.00 / $12,241.00
| Facility | | $3,206.00 | $6,578.00 | $12,241.00 |