- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,400.00 / $1,406.35 / $3,550.00
| Facility | | $1,400.00 | $1,406.35 | $3,550.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,578.80 / $1,752.40 / $1,909.26
| Facility | | $1,578.80 | $1,752.40 | $1,909.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,690.39 / $1,690.39 / $1,690.39
| Facility | | $1,690.39 | $1,690.39 | $1,690.39 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $165.05 / $165.05 / $165.05
| Facility | AS | $165.05 | $165.05 | $165.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $26,158.59 / $40,046.08 / $67,298.22
| Facility | | $26,158.59 | $40,046.08 | $67,298.22 |