- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $887.49 / $14,946.00 / $29,576.16
| Facility | | $887.49 | $14,946.00 | $29,576.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $871.09 / $971.62 / $1,058.58
| Facility | | $871.09 | $971.62 | $1,058.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $932.57 / $932.57 / $932.57
| Facility | | $932.57 | $932.57 | $932.57 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $92.68 / $92.68 / $92.68
| Facility | AS | $92.68 | $92.68 | $92.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,552.58 / $14,625.44 / $32,852.67
| Facility | | $1,552.58 | $14,625.44 | $32,852.67 |