- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,022.58 / $1,400.00 / $2,300.00
| Facility | | $1,022.58 | $1,400.00 | $2,300.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,103.29 / $1,231.36 / $1,341.59
| Facility | | $1,103.29 | $1,231.36 | $1,341.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,178.07 / $1,178.07 / $1,178.07
| Facility | | $1,178.07 | $1,178.07 | $1,178.07 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $116.84 / $116.84 / $116.84
| Facility | AS | $116.84 | $116.84 | $116.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,098.59 / $15,098.59 / $15,098.59
| Facility | | $15,098.59 | $15,098.59 | $15,098.59 |