- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,027.35 / $1,400.00 / $23,656.96
| Facility | | $1,027.35 | $1,400.00 | $23,656.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $988.48 / $1,083.94 / $1,292.35
| Facility | | $988.48 | $1,083.94 | $1,292.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,181.83 / $1,181.83 / $1,181.83
| Facility | | $1,181.83 | $1,181.83 | $1,181.83 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $118.18 / $118.18 / $118.18
| Facility | AS | $118.18 | $118.18 | $118.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $24,902.17 / $24,902.17 / $24,902.17
| Facility | | $24,902.17 | $24,902.17 | $24,902.17 |