- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $561.44 / $617.58 / $1,400.00
| Facility | | $561.44 | $617.58 | $1,400.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $609.21 / $677.45 / $738.09
| Facility | | $609.21 | $677.45 | $738.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $654.32 / $654.32 / $654.32
| Facility | | $654.32 | $654.32 | $654.32 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $65.13 / $65.13 / $65.13
| Facility | AS | $65.13 | $65.13 | $65.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20,469.15 / $29,507.23 / $33,529.18
| Facility | | $20,469.15 | $29,507.23 | $33,529.18 |