- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $747.42 / $747.42 / $2,600.00
| Facility | | $747.42 | $747.42 | $2,600.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $726.70 / $775.07 / $950.10
| Facility | | $726.70 | $775.07 | $950.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $828.12 / $828.12 / $828.12
| Facility | | $828.12 | $828.12 | $828.12 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $81.50 / $81.50 / $81.50
| Facility | AS | $81.50 | $81.50 | $81.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,273.06 / $14,273.06 / $14,273.06
| Facility | | $14,273.06 | $14,273.06 | $14,273.06 |