- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $900.76 / $1,400.00 / $6,695.26
| Facility | | $900.76 | $1,400.00 | $6,695.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $953.03 / $1,064.45 / $1,159.73
| Facility | | $953.03 | $1,064.45 | $1,159.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.24 / $1,023.24 / $1,023.24
| Facility | | $1,023.24 | $1,023.24 | $1,023.24 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $100.36 / $100.36 / $100.36
| Facility | AS | $100.36 | $100.36 | $100.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,041.65 / $9,041.65 / $39,653.48
| Facility | | $9,041.65 | $9,041.65 | $39,653.48 |