- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,324.81 / $1,324.81 / $3,550.00
| Facility | | $1,324.81 | $1,324.81 | $3,550.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,399.45 / $1,574.41 / $1,715.34
| Facility | | $1,399.45 | $1,574.41 | $1,715.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,503.07 / $1,503.07 / $1,503.07
| Facility | | $1,503.07 | $1,503.07 | $1,503.07 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $147.79 / $147.79 / $147.79
| Facility | AS | $147.79 | $147.79 | $147.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,323.99 / $21,873.54 / $26,491.78
| Facility | | $10,323.99 | $21,873.54 | $26,491.78 |