- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,297.02 / $1,829.26 / $30,810.22
| Facility | | $1,297.02 | $1,829.26 | $30,810.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,265.14 / $1,416.62 / $1,543.44
| Facility | | $1,265.14 | $1,416.62 | $1,543.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,352.50 / $1,352.50 / $1,352.50
| Facility | | $1,352.50 | $1,352.50 | $1,352.50 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $134.18 / $134.18 / $134.18
| Facility | AS | $134.18 | $134.18 | $134.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,251.23 / $14,251.23 / $14,251.23
| Facility | | $14,251.23 | $14,251.23 | $14,251.23 |