- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $758.58 / $758.58 / $2,630.27
| Facility | | $758.58 | $758.58 | $2,630.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,479.11 / $3,388.44 / $7,079.46
| Facility | | $1,479.11 | $3,388.44 | $7,079.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $2,884.03 / $6,918.31
| Facility | | $1,819.70 | $2,884.03 | $6,918.31 |
- 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
- $2,238.72 / $2,818.38 / $5,495.41
| Facility | | $2,238.72 | $2,818.38 | $5,495.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $776.25 / $1,202.26 / $2,398.83
| Facility | | $776.25 | $1,202.26 | $2,398.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $3,467.37 / $6,760.83
| Facility | | $1,230.27 | $3,467.37 | $6,760.83 |