- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,412.54 / $1,621.81 / $2,570.40
| Facility | | $1,412.54 | $1,621.81 | $2,570.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,737.80 / $1,737.80 / $2,137.96
| Facility | | $1,737.80 | $1,737.80 | $2,137.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.67 / $2,754.23 / $2,754.23
| Facility | | $34.67 | $2,754.23 | $2,754.23 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $275.42 / $275.42 / $275.42
| Facility | AS | $275.42 | $275.42 | $275.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,466.84 / $4,466.84 / $20,417.38
| Facility | | $4,466.84 | $4,466.84 | $20,417.38 |