- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,137.65 / $4,933.00 / $10,303.00
| Facility | | $1,137.65 | $4,933.00 | $10,303.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,195.00 / $10,566.00 / $19,382.01
| Facility | | $5,195.00 | $10,566.00 | $19,382.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,094.69 / $1,094.69 / $1,528.50
| Facility | | $1,094.69 | $1,094.69 | $1,528.50 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $108.38 / $108.38 / $108.38
| Facility | AS | $108.38 | $108.38 | $108.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,637.00 / $5,735.00 / $9,622.00
| Facility | | $2,637.00 | $5,735.00 | $9,622.00 |