- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $829.38 / $2,853.50 / $8,361.00
| Facility | | $829.38 | $2,853.50 | $8,361.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,512.00 / $7,178.00 / $13,734.00
| Facility | | $3,512.00 | $7,178.00 | $13,734.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,804.75 / $27,770.10 / $27,770.10
| Facility | | $5,804.75 | $27,770.10 | $27,770.10 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $227.91 / $2,632.21 / $2,632.21
| Facility | AS | $227.91 | $2,632.21 | $2,632.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,959.00 / $8,273.00 / $12,407.00
| Facility | | $3,959.00 | $8,273.00 | $12,407.00 |