- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $676.08 / $1,659.59 / $4,168.69
| Facility | | $676.08 | $1,659.59 | $4,168.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,630.78 / $7,762.47 / $21,877.62
| Facility | | $3,630.78 | $7,762.47 | $21,877.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $39.81 / $776.25 / $776.25
| Facility | | $39.81 | $776.25 | $776.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $489.78 / $812.83 / $1,445.44
| Facility | | $489.78 | $812.83 | $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
- $467.74 / $1,445.44 / $4,168.69
| Facility | | $467.74 | $1,445.44 | $4,168.69 |