- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,109.58 / $3,682.00 / $8,229.00
| Facility | | $1,109.58 | $3,682.00 | $8,229.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,452.00 / $7,363.00 / $12,538.00
| Facility | | $4,452.00 | $7,363.00 | $12,538.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,092.83 / $1,092.83 / $4,347.05
| Facility | | $1,092.83 | $1,092.83 | $4,347.05 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $106.22 / $106.22 / $106.22
| Facility | AS | $106.22 | $106.22 | $106.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,596.00 / $9,193.00 / $15,824.00
| Facility | | $4,596.00 | $9,193.00 | $15,824.00 |