- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,699.28 / $10,301.93 / $10,301.93
| Facility | | $1,699.28 | $10,301.93 | $10,301.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,185.85 / $1,315.97 / $1,433.77
| Facility | | $1,185.85 | $1,315.97 | $1,433.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,269.92 / $1,269.92 / $1,269.92
| Facility | | $1,269.92 | $1,269.92 | $1,269.92 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $126.27 / $126.27 / $126.27
| Facility | AS | $126.27 | $126.27 | $126.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,097.34 / $10,097.34 / $10,097.34
| Facility | | $10,097.34 | $10,097.34 | $10,097.34 |