- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $257.04 / $257.04 / $257.04
| Facility | | $257.04 | $257.04 | $257.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,548.82 / $6,025.60 / $14,454.40
| Facility | | $1,548.82 | $6,025.60 | $14,454.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $851.14 / $2,041.74
| Facility | | $602.56 | $851.14 | $2,041.74 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $43.65 / $43.65 / $43.65
| Facility | AS | $43.65 | $43.65 | $43.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $660.69 / $831.76 / $1,621.81
| Facility | | $660.69 | $831.76 | $1,621.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $371.54 / $616.60 / $13,182.57
| Facility | | $371.54 | $616.60 | $13,182.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,309.57 / $14,125.38 / $40,738.03
| Facility | | $6,309.57 | $14,125.38 | $40,738.03 |