- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $888.60 / $1,377.57 / $12,658.38
| Facility | | $888.60 | $1,377.57 | $12,658.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $951.59 / $1,066.82 / $1,162.32
| Facility | | $951.59 | $1,066.82 | $1,162.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,017.08 / $1,017.08 / $1,017.08
| Facility | | $1,017.08 | $1,017.08 | $1,017.08 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $100.81 / $100.81 / $100.81
| Facility | AS | $100.81 | $100.81 | $100.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23,518.86 / $23,518.86 / $32,363.33
| Facility | | $23,518.86 | $23,518.86 | $32,363.33 |