- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,103.55 / $2,678.00 / $7,602.00
| Facility | | $1,103.55 | $2,678.00 | $7,602.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,047.00 / $3,728.00 / $5,959.00
| Facility | | $2,047.00 | $3,728.00 | $5,959.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $11,028.25 / $11,028.25
| Facility | | $55.00 | $11,028.25 | $11,028.25 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $145.07 / $1,045.32 / $1,045.32
| Facility | AS | $145.07 | $1,045.32 | $1,045.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,259.00 / $4,567.00 / $7,669.00
| Facility | | $2,259.00 | $4,567.00 | $7,669.00 |