- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $882.71 / $1,351.80 / $6,203.40
| Facility | | $882.71 | $1,351.80 | $6,203.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $873.49 / $965.30 / $1,051.72
| Facility | | $873.49 | $965.30 | $1,051.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $939.63 / $939.63 / $939.63
| Facility | | $939.63 | $939.63 | $939.63 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $93.73 / $93.73 / $93.73
| Facility | AS | $93.73 | $93.73 | $93.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,663.93 / $5,692.94 / $16,158.20
| Facility | | $2,663.93 | $5,692.94 | $16,158.20 |