- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $741.31 / $741.31 / $2,290.87
| Facility | | $741.31 | $741.31 | $2,290.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $794.33 / $794.33 / $977.24
| Facility | | $794.33 | $794.33 | $977.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,288.25 / $1,288.25 / $2,290.87
| Facility | | $1,288.25 | $1,288.25 | $2,290.87 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $128.82 / $128.82 / $128.82
| Facility | AS | $128.82 | $128.82 | $128.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $2,884.03 / $20,417.38
| Facility | | $2,884.03 | $2,884.03 | $20,417.38 |