- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,965.54 / $3,965.54 / $7,136.48
| Facility | | $3,965.54 | $3,965.54 | $7,136.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $762.97 / $847.49 / $923.35
| Facility | | $762.97 | $847.49 | $923.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $821.34 / $821.34 / $821.34
| Facility | | $821.34 | $821.34 | $821.34 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $81.31 / $81.31 / $81.31
| Facility | AS | $81.31 | $81.31 | $81.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,109.20 / $9,109.20 / $9,109.20
| Facility | | $9,109.20 | $9,109.20 | $9,109.20 |