- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,445.44 / $3,890.45 / $8,511.38
| Facility | | $1,445.44 | $3,890.45 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.25 / $891.25 / $891.25
| Facility | | $891.25 | $891.25 | $891.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,445.44 / $2,238.72 / $11,748.98
| Facility | | $1,445.44 | $2,238.72 | $11,748.98 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $380.19 / $707.95 / $707.95
| Facility | AS | $380.19 | $707.95 | $707.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,949.84 / $7,762.47 / $14,454.40
| Facility | | $1,949.84 | $7,762.47 | $14,454.40 |