- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,249.44 / $1,400.00 / $2,600.00
| Facility | | $1,249.44 | $1,400.00 | $2,600.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,341.21 / $1,502.83 / $1,637.36
| Facility | | $1,341.21 | $1,502.83 | $1,637.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,433.27 / $1,433.27 / $1,433.27
| Facility | | $1,433.27 | $1,433.27 | $1,433.27 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $142.16 / $142.16 / $142.16
| Facility | AS | $142.16 | $142.16 | $142.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30,869.64 / $30,869.64 / $30,869.64
| Facility | | $30,869.64 | $30,869.64 | $30,869.64 |