- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,110.00 / $4,470.00 / $12,154.00
| Facility | | $1,110.00 | $4,470.00 | $12,154.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,088.00 / $4,279.00 / $10,043.00
| Facility | | $2,088.00 | $4,279.00 | $10,043.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $1,015.66 / $3,219.61
| Facility | | $55.00 | $1,015.66 | $3,219.61 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $218.27 / $408.43 / $408.43
| Facility | AS | $218.27 | $408.43 | $408.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $245.00 / $760.00 / $1,300.00
| Facility | | $245.00 | $760.00 | $1,300.00 |