- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,701.31 / $3,780.06 / $7,920.26
| Facility | | $1,701.31 | $3,780.06 | $7,920.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,754.10 / $16,184.00 / $28,048.48
| Facility | | $7,754.10 | $16,184.00 | $28,048.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,047.60 / $2,047.60 / $4,890.73
| Facility | | $2,047.60 | $2,047.60 | $4,890.73 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $202.96 / $202.96 / $202.96
| Facility | AS | $202.96 | $202.96 | $202.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,185.00 / $3,269.00 / $7,384.00
| Facility | | $1,185.00 | $3,269.00 | $7,384.00 |