- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,700.00 / $9,439.48 / $9,439.48
| Facility | | $1,700.00 | $9,439.48 | $9,439.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $936.18 / $1,071.30 / $1,167.20
| Facility | | $936.18 | $1,071.30 | $1,167.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,011.79 / $1,011.79 / $1,011.79
| Facility | | $1,011.79 | $1,011.79 | $1,011.79 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $100.77 / $100.77 / $100.77
| Facility | AS | $100.77 | $100.77 | $100.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,959.32 / $17,959.32 / $17,959.32
| Facility | | $17,959.32 | $17,959.32 | $17,959.32 |