- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $512.86 / $4,073.80 / $8,511.38
| Facility | | $512.86 | $4,073.80 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $676.08 / $1,819.70 / $4,168.69
| Facility | | $676.08 | $1,819.70 | $4,168.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $446.68 / $812.83 / $9,772.37
| Facility | | $446.68 | $812.83 | $9,772.37 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $125.89 / $851.14 / $851.14
| Facility | AS | $125.89 | $851.14 | $851.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $2,630.27 / $4,677.35
| Facility | | $1,819.70 | $2,630.27 | $4,677.35 |