- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $7,838.38 / $7,838.38
| Facility | | $1,000.00 | $7,838.38 | $7,838.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,147.16 / $1,147.16 / $1,147.16
| Facility | | $1,147.16 | $1,147.16 | $1,147.16 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $112.52 / $112.52 / $112.52
| Facility | AS | $112.52 | $112.52 | $112.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $909.93 / $1,158.08 / $1,519.52
| Facility | | $909.93 | $1,158.08 | $1,519.52 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $112.52 / $112.52 / $112.52
| Facility | AS | $112.52 | $112.52 | $112.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $755.00 / $4,616.00 / $17,636.00
| Facility | | $755.00 | $4,616.00 | $17,636.00 |