- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,122.02 / $1,122.02 / $5,011.87
| Facility | | $1,122.02 | $1,122.02 | $5,011.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,606.93 / $24,547.09 / $58,884.37
| Facility | | $6,606.93 | $24,547.09 | $58,884.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $4,073.80 / $9,772.37
| Facility | | $2,884.03 | $4,073.80 | $9,772.37 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $190.55 / $190.55 / $190.55
| Facility | AS | $190.55 | $190.55 | $190.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,162.28 / $3,981.07 / $7,585.78
| Facility | | $3,162.28 | $3,981.07 | $7,585.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $588.84 / $2,137.96 / $7,762.47
| Facility | | $588.84 | $2,137.96 | $7,762.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,818.38 / $5,011.87 / $10,715.19
| Facility | | $2,818.38 | $5,011.87 | $10,715.19 |