- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,180.71 / $1,180.71 / $1,794.96
| Facility | | $1,180.71 | $1,180.71 | $1,794.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,217.76 / $1,390.07 / $1,514.50
| Facility | | $1,217.76 | $1,390.07 | $1,514.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,307.42 / $1,307.42 / $1,307.42
| Facility | | $1,307.42 | $1,307.42 | $1,307.42 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $128.13 / $128.13 / $128.13
| Facility | AS | $128.13 | $128.13 | $128.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $765.00 / $765.00 / $765.00
| Facility | | $765.00 | $765.00 | $765.00 |