- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,612.44 / $9,612.44 / $14,872.68
| Facility | | $9,612.44 | $9,612.44 | $14,872.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $604.76 / $676.51 / $737.07
| Facility | | $604.76 | $676.51 | $737.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $650.60 / $650.60 / $650.60
| Facility | | $650.60 | $650.60 | $650.60 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $64.05 / $64.05 / $64.05
| Facility | AS | $64.05 | $64.05 | $64.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,869.21 / $2,869.21 / $2,869.21
| Facility | | $2,869.21 | $2,869.21 | $2,869.21 |