- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $512.86 / $5,888.44 / $7,244.36
| Facility | | $512.86 | $5,888.44 | $7,244.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,890.45 / $13,803.84 / $21,379.62
| Facility | | $3,890.45 | $13,803.84 | $21,379.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $588.84 / $588.84 / $3,388.44
| Facility | | $588.84 | $588.84 | $3,388.44 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $58.88 / $58.88 / $58.88
| Facility | AS | $58.88 | $58.88 | $58.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $331.13 / $446.68 / $794.33
| Facility | | $331.13 | $446.68 | $794.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.25 / $8,912.51 / $26,302.68
| Facility | | $891.25 | $8,912.51 | $26,302.68 |