- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,570.40 / $3,715.35 / $6,456.54
| Facility | | $2,570.40 | $3,715.35 | $6,456.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,570.40 / $5,370.32 / $20,892.96
| Facility | | $2,570.40 | $5,370.32 | $20,892.96 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $2,137.96 / $2,137.96 / $2,137.96
| Facility | AS | $2,137.96 | $2,137.96 | $2,137.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $1,995.26 / $1,995.26
| Facility | | $1,995.26 | $1,995.26 | $1,995.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $954.99 / $2,754.23 / $7,079.46
| Facility | | $954.99 | $2,754.23 | $7,079.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,570.40 / $6,918.31 / $15,488.17
| Facility | | $2,570.40 | $6,918.31 | $15,488.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,818.38 / $5,370.32 / $20,892.96
| Facility | | $2,818.38 | $5,370.32 | $20,892.96 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $2,137.96 / $2,137.96 / $2,137.96
| Facility | AS | $2,137.96 | $2,137.96 | $2,137.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,570.40 / $7,244.36 / $16,595.87
| Facility | | $2,570.40 | $7,244.36 | $16,595.87 |