- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $958.83 / $1,400.00 / $3,550.00
| Facility | | $958.83 | $1,400.00 | $3,550.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,035.86 / $1,156.70 / $1,260.25
| Facility | | $1,035.86 | $1,156.70 | $1,260.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,108.89 / $1,108.89 / $1,108.89
| Facility | | $1,108.89 | $1,108.89 | $1,108.89 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $110.09 / $110.09 / $110.09
| Facility | AS | $110.09 | $110.09 | $110.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30,423.73 / $30,423.73 / $30,423.73
| Facility | | $30,423.73 | $30,423.73 | $30,423.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20,028.63 / $20,028.63 / $20,028.63
| Facility | | $20,028.63 | $20,028.63 | $20,028.63 |