- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,412.54 / $1,513.56 / $3,019.95
| Facility | | $1,412.54 | $1,513.56 | $3,019.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,621.81 / $1,621.81 / $1,995.26
| Facility | | $1,621.81 | $1,621.81 | $1,995.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.67 / $2,570.40 / $2,570.40
| Facility | | $34.67 | $2,570.40 | $2,570.40 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $257.04 / $257.04 / $257.04
| Facility | AS | $257.04 | $257.04 | $257.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,466.84 / $4,466.84 / $35,481.34
| Facility | | $4,466.84 | $4,466.84 | $35,481.34 |