- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,648.45 / $2,648.45 / $3,854.00
| Facility | | $2,648.45 | $2,648.45 | $3,854.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $460.80 / $510.17 / $555.84
| Facility | | $460.80 | $510.17 | $555.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $497.34 / $497.34 / $497.34
| Facility | | $497.34 | $497.34 | $497.34 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $49.32 / $49.32 / $49.32
| Facility | AS | $49.32 | $49.32 | $49.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,850.86 / $8,850.86 / $8,850.86
| Facility | | $8,850.86 | $8,850.86 | $8,850.86 |