- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,174.90 / $1,174.90 / $6,760.83
| Facility | | $1,174.90 | $1,174.90 | $6,760.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,079.46 / $16,595.87 / $32,359.37
| Facility | | $7,079.46 | $16,595.87 | $32,359.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,019.95 / $4,265.80 / $10,232.93
| Facility | | $3,019.95 | $4,265.80 | $10,232.93 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $199.53 / $199.53 / $199.53
| Facility | AS | $199.53 | $199.53 | $199.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,311.31 / $4,168.69 / $7,943.28
| Facility | | $3,311.31 | $4,168.69 | $7,943.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.26 / $2,290.87 / $8,511.38
| Facility | | $1,202.26 | $2,290.87 | $8,511.38 |
- 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 |