- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $275.33 / $419.86 / $2,300.00
| Facility | | $275.33 | $419.86 | $2,300.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $270.95 / $289.89 / $354.25
| Facility | | $270.95 | $289.89 | $354.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $311.69 / $311.69 / $311.69
| Facility | | $311.69 | $311.69 | $311.69 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $30.65 / $30.65 / $30.65
| Facility | AS | $30.65 | $30.65 | $30.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,818.88 / $5,818.88 / $5,818.88
| Facility | | $5,818.88 | $5,818.88 | $5,818.88 |