- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,400.00 / $25,236.11 / $25,236.11
| Facility | | $1,400.00 | $25,236.11 | $25,236.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,070.64 / $1,193.15 / $1,299.96
| Facility | | $1,070.64 | $1,193.15 | $1,299.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,145.58 / $1,145.58 / $1,145.58
| Facility | | $1,145.58 | $1,145.58 | $1,145.58 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $113.45 / $113.45 / $113.45
| Facility | AS | $113.45 | $113.45 | $113.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,691.23 / $10,691.23 / $10,691.23
| Facility | | $10,691.23 | $10,691.23 | $10,691.23 |