- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,400.00 / $1,589.37 / $3,050.00
| Facility | | $1,400.00 | $1,589.37 | $3,050.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,665.38 / $1,919.74 / $2,091.58
| Facility | | $1,665.38 | $1,919.74 | $2,091.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,780.07 / $1,780.07 / $1,780.07
| Facility | | $1,780.07 | $1,780.07 | $1,780.07 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $176.68 / $176.68 / $176.68
| Facility | AS | $176.68 | $176.68 | $176.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,433.46 / $35,327.79 / $100,695.88
| Facility | | $19,433.46 | $35,327.79 | $100,695.88 |