- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $479.01 / $753.87 / $1,700.00
| Facility | | $479.01 | $753.87 | $1,700.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $527.20 / $583.80 / $636.08
| Facility | | $527.20 | $583.80 | $636.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $568.77 / $568.77 / $568.77
| Facility | | $568.77 | $568.77 | $568.77 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $56.45 / $56.45 / $56.45
| Facility | AS | $56.45 | $56.45 | $56.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,367.81 / $6,367.81 / $10,222.87
| Facility | | $6,367.81 | $6,367.81 | $10,222.87 |