- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,030.24 / $4,510.50 / $8,828.00
| Facility | | $1,030.24 | $4,510.50 | $8,828.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,302.10 / $6,548.00 / $11,253.00
| Facility | | $3,302.10 | $6,548.00 | $11,253.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,000.00 / $3,616.11
| Facility | | $1,000.00 | $1,000.00 | $3,616.11 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $87.17 / $87.17 / $87.17
| Facility | AS | $87.17 | $87.17 | $87.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,637.00 / $5,920.00 / $9,810.00
| Facility | | $2,637.00 | $5,920.00 | $9,810.00 |