- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $801.56 / $1,249.85 / $15,870.13
| Facility | | $801.56 | $1,249.85 | $15,870.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $866.84 / $967.92 / $1,054.57
| Facility | | $866.84 | $967.92 | $1,054.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $928.11 / $928.11 / $928.11
| Facility | | $928.11 | $928.11 | $928.11 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $92.05 / $92.05 / $92.05
| Facility | AS | $92.05 | $92.05 | $92.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23,828.71 / $23,828.71 / $23,828.71
| Facility | | $23,828.71 | $23,828.71 | $23,828.71 |