- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,391.00 / $4,341.45 / $10,746.00
| Facility | | $1,391.00 | $4,341.45 | $10,746.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,803.00 / $5,196.00 / $7,507.00
| Facility | | $2,803.00 | $5,196.00 | $7,507.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,027.75 / $12,623.50 / $26,542.00
| Facility | | $4,027.75 | $12,623.50 | $26,542.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $220.87 / $1,196.53 / $1,196.53
| Facility | AS | $220.87 | $1,196.53 | $1,196.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,799.00 / $5,728.00 / $10,111.00
| Facility | | $2,799.00 | $5,728.00 | $10,111.00 |