- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $466.04 / $732.35 / $2,300.00
| Facility | | $466.04 | $732.35 | $2,300.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $510.25 / $567.16 / $617.91
| Facility | | $510.25 | $567.16 | $617.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $549.79 / $549.79 / $549.79
| Facility | | $549.79 | $549.79 | $549.79 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $54.47 / $54.47 / $54.47
| Facility | AS | $54.47 | $54.47 | $54.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,681.06 / $8,681.06 / $8,681.06
| Facility | | $8,681.06 | $8,681.06 | $8,681.06 |