- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,110.00 / $3,351.00 / $8,000.00
| Facility | | $1,110.00 | $3,351.00 | $8,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,088.00 / $4,247.00 / $9,663.00
| Facility | | $2,088.00 | $4,247.00 | $9,663.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $723.51 / $1,433.24 / $16,394.00
| Facility | | $723.51 | $1,433.24 | $16,394.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $193.68 / $5,739.78 / $5,739.78
| Facility | AS | $193.68 | $5,739.78 | $5,739.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,176.00 / $5,241.00 / $13,596.00
| Facility | | $3,176.00 | $5,241.00 | $13,596.00 |