- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,593.31 / $3,706.14 / $8,031.00
| Facility | | $1,593.31 | $3,706.14 | $8,031.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,573.95 / $8,109.09 / $13,917.11
| Facility | | $3,573.95 | $8,109.09 | $13,917.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $680.00 / $870.49 / $1,806.52
| Facility | | $680.00 | $870.49 | $1,806.52 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $176.72 / $176.72 / $176.72
| Facility | AS | $176.72 | $176.72 | $176.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $718.00 / $2,575.00 / $7,326.50
| Facility | | $718.00 | $2,575.00 | $7,326.50 |