- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $688.21 / $1,071.83 / $1,700.00
| Facility | | $688.21 | $1,071.83 | $1,700.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $738.69 / $830.06 / $904.37
| Facility | | $738.69 | $830.06 | $904.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $787.96 / $787.96 / $787.96
| Facility | | $787.96 | $787.96 | $787.96 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $78.22 / $78.22 / $78.22
| Facility | AS | $78.22 | $78.22 | $78.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,598.78 / $10,598.78 / $12,029.87
| Facility | | $10,598.78 | $10,598.78 | $12,029.87 |