- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $787.00 / $1,758.00 / $15,750.43
| Facility | | $787.00 | $1,758.00 | $15,750.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,104.00 / $5,280.00 / $10,933.00
| Facility | | $3,104.00 | $5,280.00 | $10,933.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $870.78 / $1,195.18 / $1,378.74
| Facility | | $870.78 | $1,195.18 | $1,378.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,047.98 / $1,047.98 / $1,047.98
| Facility | | $1,047.98 | $1,047.98 | $1,047.98 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $102.97 / $102.97 / $102.97
| Facility | AS | $102.97 | $102.97 | $102.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $847.00 / $1,475.00 / $12,296.00
| Facility | | $847.00 | $1,475.00 | $12,296.00 |