- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $5,623.41 / $14,125.38
| Facility | | $1,513.56 | $5,623.41 | $14,125.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,570.88 / $11,748.98 / $23,988.33
| Facility | | $4,570.88 | $11,748.98 | $23,988.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $3,981.07 / $15,488.17
| Facility | | $1,995.26 | $3,981.07 | $15,488.17 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $208.93 / $208.93 / $208.93
| Facility | AS | $208.93 | $208.93 | $208.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,019.95 / $8,709.64 / $20,417.38
| Facility | | $3,019.95 | $8,709.64 | $20,417.38 |