- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.83 / $1,584.89 / $7,585.78
| Facility | | $812.83 | $1,584.89 | $7,585.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,585.78 / $9,120.11 / $12,302.69
| Facility | | $7,585.78 | $9,120.11 | $12,302.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,659.59 / $1,659.59 / $1,659.59
| Facility | | $1,659.59 | $1,659.59 | $1,659.59 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $165.96 / $165.96 / $165.96
| Facility | AS | $165.96 | $165.96 | $165.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $5,370.32 / $9,120.11
| Facility | | $2,454.71 | $5,370.32 | $9,120.11 |