- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,205.93 / $1,205.93 / $2,600.00
| Facility | | $1,205.93 | $1,205.93 | $2,600.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,193.22 / $1,324.57 / $1,443.14
| Facility | | $1,193.22 | $1,324.57 | $1,443.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,277.86 / $1,277.86 / $1,277.86
| Facility | | $1,277.86 | $1,277.86 | $1,277.86 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $124.67 / $124.67 / $124.67
| Facility | AS | $124.67 | $124.67 | $124.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,771.81 / $18,328.65 / $47,085.86
| Facility | | $9,771.81 | $18,328.65 | $47,085.86 |