- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $310.20 / $12,058.32 / $17,248.06
| Facility | | $310.20 | $12,058.32 | $17,248.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $824.21 / $919.06 / $1,001.32
| Facility | | $824.21 | $919.06 | $1,001.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $881.98 / $881.98 / $881.98
| Facility | | $881.98 | $881.98 | $881.98 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $87.65 / $87.65 / $87.65
| Facility | AS | $87.65 | $87.65 | $87.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,823.85 / $17,140.15 / $29,716.59
| Facility | | $6,823.85 | $17,140.15 | $29,716.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,522.00 / $3,522.00 / $3,522.00
| Facility | | $3,522.00 | $3,522.00 | $3,522.00 |