- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $524.74 / $823.31 / $1,700.00
| Facility | | $524.74 | $823.31 | $1,700.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $571.95 / $637.58 / $694.67
| Facility | | $571.95 | $637.58 | $694.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $614.15 / $614.15 / $614.15
| Facility | | $614.15 | $614.15 | $614.15 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $60.88 / $60.88 / $60.88
| Facility | AS | $60.88 | $60.88 | $60.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,241.86 / $10,241.86 / $10,650.98
| Facility | | $10,241.86 | $10,241.86 | $10,650.98 |