- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,341.64 / $3,829.00 / $8,238.00
| Facility | | $1,341.64 | $3,829.00 | $8,238.00 |
- 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
- $1,554.94 / $1,554.94 / $2,157.36
| Facility | | $1,554.94 | $1,554.94 | $2,157.36 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $152.97 / $152.97 / $152.97
| Facility | AS | $152.97 | $152.97 | $152.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,403.00 / $3,325.00 / $8,198.00
| Facility | | $1,403.00 | $3,325.00 | $8,198.00 |