- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $970.05 / $12,634.23 / $12,634.23
| Facility | | $970.05 | $12,634.23 | $12,634.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $680.34 / $751.22 / $818.48
| Facility | | $680.34 | $751.22 | $818.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $727.61 / $727.61 / $727.61
| Facility | | $727.61 | $727.61 | $727.61 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $72.09 / $72.09 / $72.09
| Facility | AS | $72.09 | $72.09 | $72.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,967.60 / $1,967.60 / $1,967.60
| Facility | | $1,967.60 | $1,967.60 | $1,967.60 |