- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,696.26 / $10,301.93 / $10,301.93
| Facility | | $1,696.26 | $10,301.93 | $10,301.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,180.44 / $1,313.63 / $1,431.22
| Facility | | $1,180.44 | $1,313.63 | $1,431.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,267.35 / $1,267.35 / $1,267.35
| Facility | | $1,267.35 | $1,267.35 | $1,267.35 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $126.35 / $126.35 / $126.35
| Facility | AS | $126.35 | $126.35 | $126.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,796.98 / $25,051.77 / $65,517.00
| Facility | | $12,796.98 | $25,051.77 | $65,517.00 |