- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $645.65 / $2,511.89 / $7,413.10
| Facility | | $645.65 | $2,511.89 | $7,413.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,089.30 / $3,715.35 / $7,413.10
| Facility | | $2,089.30 | $3,715.35 | $7,413.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $588.84 / $1,698.24 / $1,698.24
| Facility | | $588.84 | $1,698.24 | $1,698.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,047.13 / $1,862.09 / $2,344.23
| Facility | | $1,047.13 | $1,862.09 | $2,344.23 |
- 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
- $933.25 / $933.25 / $7,943.28
| Facility | | $933.25 | $933.25 | $7,943.28 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $794.33 / $794.33 / $794.33
| Facility | AS | $794.33 | $794.33 | $794.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $851.14 / $2,570.40
| Facility | | $602.56 | $851.14 | $2,570.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $794.33 / $1,412.54
| Facility | | $602.56 | $794.33 | $1,412.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,380.38 / $3,981.07 / $8,511.38
| Facility | | $1,380.38 | $3,981.07 | $8,511.38 |