- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,317.75 / $3,650.50 / $8,238.00
| Facility | | $1,317.75 | $3,650.50 | $8,238.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,769.10 / $8,883.46 / $15,216.00
| Facility | | $4,769.10 | $8,883.46 | $15,216.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,322.09 / $1,322.09 / $3,511.04
| Facility | | $1,322.09 | $1,322.09 | $3,511.04 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $128.18 / $128.18 / $128.18
| Facility | AS | $128.18 | $128.18 | $128.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,403.00 / $3,325.00 / $8,152.00
| Facility | | $1,403.00 | $3,325.00 | $8,152.00 |