- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,592.45 / $13,107.18 / $13,107.18
| Facility | | $1,592.45 | $13,107.18 | $13,107.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,103.31 / $1,233.24 / $1,343.63
| Facility | | $1,103.31 | $1,233.24 | $1,343.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,178.45 / $1,178.45 / $1,178.45
| Facility | | $1,178.45 | $1,178.45 | $1,178.45 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $116.95 / $116.95 / $116.95
| Facility | AS | $116.95 | $116.95 | $116.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20,015.28 / $20,015.28 / $20,015.28
| Facility | | $20,015.28 | $20,015.28 | $20,015.28 |