- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,530.14 / $14,611.36 / $14,611.36
| Facility | | $1,530.14 | $14,611.36 | $14,611.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,059.13 / $1,184.99 / $1,291.06
| Facility | | $1,059.13 | $1,184.99 | $1,291.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,130.74 / $1,130.74 / $1,130.74
| Facility | | $1,130.74 | $1,130.74 | $1,130.74 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $112.33 / $112.33 / $112.33
| Facility | AS | $112.33 | $112.33 | $112.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,385.47 / $7,385.47 / $59,893.75
| Facility | | $7,385.47 | $7,385.47 | $59,893.75 |