- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $721.35 / $1,093.26 / $1,400.00
| Facility | | $721.35 | $1,093.26 | $1,400.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $770.29 / $846.65 / $922.44
| Facility | | $770.29 | $846.65 | $922.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $842.95 / $842.95 / $842.95
| Facility | | $842.95 | $842.95 | $842.95 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $84.30 / $84.30 / $84.30
| Facility | AS | $84.30 | $84.30 | $84.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,535.56 / $6,535.56 / $7,336.74
| Facility | | $6,535.56 | $6,535.56 | $7,336.74 |