- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $481.63 / $755.81 / $2,300.00
| Facility | | $481.63 | $755.81 | $2,300.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $528.41 / $585.30 / $637.71
| Facility | | $528.41 | $585.30 | $637.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $569.88 / $569.88 / $569.88
| Facility | | $569.88 | $569.88 | $569.88 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $56.52 / $56.52 / $56.52
| Facility | AS | $56.52 | $56.52 | $56.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,987.77 / $7,987.77 / $7,987.77
| Facility | | $7,987.77 | $7,987.77 | $7,987.77 |