- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $489.78 / $489.78 / $6,760.83
| Facility | | $489.78 | $489.78 | $6,760.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,818.38 / $6,760.83 / $14,791.08
| Facility | | $2,818.38 | $6,760.83 | $14,791.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,258.93 / $1,819.70 / $4,265.80
| Facility | | $1,258.93 | $1,819.70 | $4,265.80 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $83.18 / $83.18 / $83.18
| Facility | AS | $83.18 | $83.18 | $83.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,380.38 / $1,737.80 / $3,388.44
| Facility | | $1,380.38 | $1,737.80 | $3,388.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $489.78 / $954.99 / $6,918.31
| Facility | | $489.78 | $954.99 | $6,918.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,398.83 / $4,786.30 / $8,912.51
| Facility | | $2,398.83 | $4,786.30 | $8,912.51 |