- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $870.96 / $2,691.53 / $6,606.93
| Facility | | $870.96 | $2,691.53 | $6,606.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.23 / $5,754.40 / $9,772.37
| Facility | | $2,344.23 | $5,754.40 | $9,772.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $588.84 / $3,090.30 / $6,165.95
| Facility | | $588.84 | $3,090.30 | $6,165.95 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $58.88 / $58.88 / $58.88
| Facility | AS | $58.88 | $58.88 | $58.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,218.10 / $16,218.10 / $33,884.42
| Facility | | $16,218.10 | $16,218.10 | $33,884.42 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $1,621.81 / $1,621.81 / $1,621.81
| Facility | AS | $1,621.81 | $1,621.81 | $1,621.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,187.76 / $5,623.41 / $10,000.00
| Facility | | $2,187.76 | $5,623.41 | $10,000.00 |