- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,258.93 / $1,380.38 / $7,762.47
| Facility | | $1,258.93 | $1,380.38 | $7,762.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,445.44 / $1,445.44 / $1,445.44
| Facility | | $1,445.44 | $1,445.44 | $1,445.44 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $144.54 / $144.54 / $144.54
| Facility | AS | $144.54 | $144.54 | $144.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $794.33 / $1,047.13 / $1,737.80
| Facility | | $794.33 | $1,047.13 | $1,737.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $562.34 / $3,467.37 / $8,317.64
| Facility | | $562.34 | $3,467.37 | $8,317.64 |