- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,677.14 / $8,677.14 / $23,881.64
| Facility | | $8,677.14 | $8,677.14 | $23,881.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,379.58 / $1,575.48 / $1,716.51
| Facility | | $1,379.58 | $1,575.48 | $1,716.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,484.26 / $1,484.26 / $1,484.26
| Facility | | $1,484.26 | $1,484.26 | $1,484.26 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $147.04 / $147.04 / $147.04
| Facility | AS | $147.04 | $147.04 | $147.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,439.00 / $4,439.00 / $4,439.00
| Facility | | $4,439.00 | $4,439.00 | $4,439.00 |