- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,400.00 / $2,092.02 / $3,195.60
| Facility | | $1,400.00 | $2,092.02 | $3,195.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,165.57 / $2,474.75 / $2,696.27
| Facility | | $2,165.57 | $2,474.75 | $2,696.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,318.78 / $2,318.78 / $2,318.78
| Facility | | $2,318.78 | $2,318.78 | $2,318.78 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $227.05 / $227.05 / $227.05
| Facility | AS | $227.05 | $227.05 | $227.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,010.34 / $7,010.34 / $7,010.34
| Facility | | $7,010.34 | $7,010.34 | $7,010.34 |