- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,119.35 / $1,913.70 / $35,509.32
| Facility | | $1,119.35 | $1,913.70 | $35,509.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,286.22 / $1,482.01 / $1,614.68
| Facility | | $1,286.22 | $1,482.01 | $1,614.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,374.86 / $1,374.86 / $1,374.86
| Facility | | $1,374.86 | $1,374.86 | $1,374.86 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $136.44 / $136.44 / $136.44
| Facility | AS | $136.44 | $136.44 | $136.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,134.07 / $13,134.07 / $13,134.07
| Facility | | $13,134.07 | $13,134.07 | $13,134.07 |