- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,047.13 / $1,047.13 / $8,128.31
| Facility | | $1,047.13 | $1,047.13 | $8,128.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $380.19 / $870.96 / $8,912.51
| Facility | | $380.19 | $870.96 | $8,912.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,691.53 / $3,801.89 / $9,120.11
| Facility | | $2,691.53 | $3,801.89 | $9,120.11 |
- 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
- $2,951.21 / $3,715.35 / $7,244.36
| Facility | | $2,951.21 | $3,715.35 | $7,244.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,122.02 / $2,041.74 / $5,888.44
| Facility | | $1,122.02 | $2,041.74 | $5,888.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $6,309.57 / $13,182.57
| Facility | | $1,584.89 | $6,309.57 | $13,182.57 |