- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,313.84 / $11,313.84 / $22,086.24
| Facility | | $11,313.84 | $11,313.84 | $22,086.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $962.36 / $1,072.43 / $1,168.43
| Facility | | $962.36 | $1,072.43 | $1,168.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,031.88 / $1,031.88 / $1,031.88
| Facility | | $1,031.88 | $1,031.88 | $1,031.88 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $102.45 / $102.45 / $102.45
| Facility | AS | $102.45 | $102.45 | $102.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,128.57 / $18,128.57 / $18,128.57
| Facility | | $18,128.57 | $18,128.57 | $18,128.57 |