- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,341.10 / $11,341.10 / $13,934.56
| Facility | | $11,341.10 | $11,341.10 | $13,934.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $626.87 / $710.83 / $774.47
| Facility | | $626.87 | $710.83 | $774.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $670.45 / $670.45 / $670.45
| Facility | | $670.45 | $670.45 | $670.45 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $66.25 / $66.25 / $66.25
| Facility | AS | $66.25 | $66.25 | $66.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,827.03 / $14,011.44 / $27,251.86
| Facility | | $3,827.03 | $14,011.44 | $27,251.86 |