- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $353.90 / $595.44 / $1,600.00
| Facility | | $353.90 | $595.44 | $1,600.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $409.46 / $502.40 / $691.69
| Facility | | $409.46 | $502.40 | $691.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $438.59 / $438.59 / $438.59
| Facility | | $438.59 | $438.59 | $438.59 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $43.55 / $43.55 / $43.55
| Facility | AS | $43.55 | $43.55 | $43.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,874.81 / $7,874.81 / $7,874.81
| Facility | | $7,874.81 | $7,874.81 | $7,874.81 |