- 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
- $1,412.54 / $2,238.72 / $11,220.18
| Facility | | $1,412.54 | $2,238.72 | $11,220.18 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $371.54 / $676.08 / $676.08
| Facility | AS | $371.54 | $676.08 | $676.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,949.84 / $7,762.47 / $15,135.61
| Facility | | $1,949.84 | $7,762.47 | $15,135.61 |