- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.76 / $831.76 / $831.76
| Facility | | $831.76 | $831.76 | $831.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,365.16 / $7,585.78 / $19,952.62
| Facility | | $4,365.16 | $7,585.78 | $19,952.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,187.76 / $3,090.30 / $7,244.36
| Facility | | $2,187.76 | $3,090.30 | $7,244.36 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $154.88 / $154.88 / $154.88
| Facility | AS | $154.88 | $154.88 | $154.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.23 / $2,951.21 / $5,754.40
| Facility | | $2,344.23 | $2,951.21 | $5,754.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $1,698.24 / $3,467.37
| Facility | | $1,023.29 | $1,698.24 | $3,467.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $3,467.37 / $8,511.38
| Facility | | $1,584.89 | $3,467.37 | $8,511.38 |