- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,292.59 / $41,243.44 / $41,243.44
| Facility | | $1,292.59 | $41,243.44 | $41,243.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,315.87 / $1,461.84 / $1,592.70
| Facility | | $1,315.87 | $1,461.84 | $1,592.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,408.44 / $1,408.44 / $1,408.44
| Facility | | $1,408.44 | $1,408.44 | $1,408.44 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $137.22 / $137.22 / $137.22
| Facility | AS | $137.22 | $137.22 | $137.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $32,751.46 / $46,456.69 / $53,342.42
| Facility | | $32,751.46 | $46,456.69 | $53,342.42 |