- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $691.83 / $2,290.87 / $19,952.62
| Facility | | $691.83 | $2,290.87 | $19,952.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $691.83 / $691.83 / $870.96
| Facility | | $691.83 | $691.83 | $870.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,122.02 / $1,122.02 / $2,290.87
| Facility | | $1,122.02 | $1,122.02 | $2,290.87 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $112.20 / $112.20 / $112.20
| Facility | AS | $112.20 | $112.20 | $112.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,466.84 / $4,466.84 / $15,488.17
| Facility | | $4,466.84 | $4,466.84 | $15,488.17 |