- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $912.01 / $912.01 / $1,412.54
| Facility | | $912.01 | $912.01 | $1,412.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $977.24 / $977.24 / $1,202.26
| Facility | | $977.24 | $977.24 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.67 / $1,548.82 / $1,548.82
| Facility | | $34.67 | $1,548.82 | $1,548.82 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $154.88 / $154.88 / $154.88
| Facility | AS | $154.88 | $154.88 | $154.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $758.58 / $758.58 / $758.58
| Facility | | $758.58 | $758.58 | $758.58 |