- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,003.73 / $4,330.00 / $8,475.50
| Facility | | $2,003.73 | $4,330.00 | $8,475.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,105.25 / $16,184.00 / $28,850.83
| Facility | | $8,105.25 | $16,184.00 | $28,850.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,520.85 / $2,520.85 / $3,528.64
| Facility | | $2,520.85 | $2,520.85 | $3,528.64 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $250.20 / $250.20 / $250.20
| Facility | AS | $250.20 | $250.20 | $250.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,367.00 / $3,236.00 / $6,792.00
| Facility | | $1,367.00 | $3,236.00 | $6,792.00 |