- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $575.44 / $1,698.24
| Facility | | $575.44 | $575.44 | $1,698.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $630.96 / $758.58
| Facility | | $630.96 | $630.96 | $758.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $1,023.29 / $1,862.09
| Facility | | $1,023.29 | $1,023.29 | $1,862.09 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $102.33 / $102.33 / $102.33
| Facility | AS | $102.33 | $102.33 | $102.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $2,884.03 / $9,120.11
| Facility | | $2,884.03 | $2,884.03 | $9,120.11 |