- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,258.00 / $4,160.00 / $8,000.00
| Facility | | $1,258.00 | $4,160.00 | $8,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,088.00 / $4,247.00 / $9,663.00
| Facility | | $2,088.00 | $4,247.00 | $9,663.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $467.67 / $803.92 / $5,620.00
| Facility | | $467.67 | $803.92 | $5,620.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $131.75 / $131.75 / $497.27
| Facility | AS | $131.75 | $131.75 | $497.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,327.60 / $2,833.00 / $5,813.00
| Facility | | $1,327.60 | $2,833.00 | $5,813.00 |