- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $253.93 / $253.93 / $1,700.00
| Facility | | $253.93 | $253.93 | $1,700.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $267.95 / $304.12 / $331.33
| Facility | | $267.95 | $304.12 | $331.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $288.42 / $288.42 / $288.42
| Facility | | $288.42 | $288.42 | $288.42 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $28.15 / $28.15 / $28.15
| Facility | AS | $28.15 | $28.15 | $28.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,357.60 / $16,357.60 / $16,357.60
| Facility | | $16,357.60 | $16,357.60 | $16,357.60 |