- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,550.90 / $14,550.90 / $15,788.95
| Facility | | $14,550.90 | $14,550.90 | $15,788.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,343.65 / $1,538.60 / $1,676.32
| Facility | | $1,343.65 | $1,538.60 | $1,676.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,438.48 / $1,438.48 / $1,438.48
| Facility | | $1,438.48 | $1,438.48 | $1,438.48 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $142.94 / $142.94 / $142.94
| Facility | AS | $142.94 | $142.94 | $142.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,487.28 / $4,487.28 / $4,487.28
| Facility | | $4,487.28 | $4,487.28 | $4,487.28 |