- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,207.94 / $23,312.00 / $35,987.90
| Facility | | $14,207.94 | $23,312.00 | $35,987.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $894.61 / $1,073.53 / $1,341.92
| Facility | | $894.61 | $1,073.53 | $1,341.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,043.79 / $1,043.79 / $1,043.79
| Facility | | $1,043.79 | $1,043.79 | $1,043.79 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $103.83 / $103.83 / $103.83
| Facility | AS | $103.83 | $103.83 | $103.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,116.47 / $20,657.56 / $36,375.41
| Facility | | $13,116.47 | $20,657.56 | $36,375.41 |