- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,146.04 / $3,617.00 / $7,920.26
| Facility | | $1,146.04 | $3,617.00 | $7,920.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,486.55 / $7,147.20 / $12,913.17
| Facility | | $3,486.55 | $7,147.20 | $12,913.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $680.00 / $870.49 / $1,229.08
| Facility | | $680.00 | $870.49 | $1,229.08 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $120.64 / $120.64 / $120.64
| Facility | AS | $120.64 | $120.64 | $120.64 |
- 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 |