- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $954.99 / $1,047.13 / $7,762.47
| Facility | | $954.99 | $1,047.13 | $7,762.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,398.83 / $5,248.07 / $8,511.38
| Facility | | $2,398.83 | $5,248.07 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,047.13 / $1,047.13 / $1,659.59
| Facility | | $1,047.13 | $1,047.13 | $1,659.59 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $104.71 / $104.71 / $104.71
| Facility | AS | $104.71 | $104.71 | $104.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $588.84 / $776.25 / $1,445.44
| Facility | | $588.84 | $776.25 | $1,445.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $645.65 / $6,025.60 / $12,022.64
| Facility | | $645.65 | $6,025.60 | $12,022.64 |