- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,368.80 / $1,928.00 / $13,977.58
| Facility | | $1,368.80 | $1,928.00 | $13,977.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,330.34 / $1,493.10 / $1,626.75
| Facility | | $1,330.34 | $1,493.10 | $1,626.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,422.64 / $1,422.64 / $1,422.64
| Facility | | $1,422.64 | $1,422.64 | $1,422.64 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $140.69 / $140.69 / $140.69
| Facility | AS | $140.69 | $140.69 | $140.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $27,839.83 / $27,839.83 / $27,839.83
| Facility | | $27,839.83 | $27,839.83 | $27,839.83 |