- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,926.85 / $5,926.85 / $9,464.87
| Facility | | $5,926.85 | $5,926.85 | $9,464.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $693.64 / $770.10 / $839.04
| Facility | | $693.64 | $770.10 | $839.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $740.17 / $740.17 / $740.17
| Facility | | $740.17 | $740.17 | $740.17 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $73.45 / $73.45 / $73.45
| Facility | AS | $73.45 | $73.45 | $73.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,917.62 / $2,917.62 / $13,223.44
| Facility | | $2,917.62 | $2,917.62 | $13,223.44 |