- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,762.56 / $17,409.75 / $27,606.86
| Facility | | $1,762.56 | $17,409.75 | $27,606.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,217.93 / $1,364.98 / $1,487.16
| Facility | | $1,217.93 | $1,364.98 | $1,487.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,300.96 / $1,300.96 / $1,300.96
| Facility | | $1,300.96 | $1,300.96 | $1,300.96 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $128.96 / $128.96 / $128.96
| Facility | AS | $128.96 | $128.96 | $128.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30,529.07 / $37,840.19 / $58,779.78
| Facility | | $30,529.07 | $37,840.19 | $58,779.78 |