- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,084.76 / $14,752.36 / $15,508.50
| Facility | | $1,084.76 | $14,752.36 | $15,508.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,024.55 / $1,167.85 / $1,272.40
| Facility | | $1,024.55 | $1,167.85 | $1,272.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,095.64 / $1,095.64 / $1,095.64
| Facility | | $1,095.64 | $1,095.64 | $1,095.64 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $107.75 / $107.75 / $107.75
| Facility | AS | $107.75 | $107.75 | $107.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,111.76 / $15,111.76 / $27,904.14
| Facility | | $15,111.76 | $15,111.76 | $27,904.14 |