- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,258.93 / $3,311.31 / $18,197.01
| Facility | | $1,258.93 | $3,311.31 | $18,197.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,754.23 / $6,606.93 / $9,772.37
| Facility | | $2,754.23 | $6,606.93 | $9,772.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30.20 / $30.20 / $30.20
| Facility | | $30.20 | $30.20 | $30.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $54.95 / $10,715.19 / $10,715.19
| Facility | | $54.95 | $10,715.19 | $10,715.19 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $1,071.52 / $1,071.52 / $1,071.52
| Facility | AS | $1,071.52 | $1,071.52 | $1,071.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,235.94 / $5,754.40 / $10,232.93
| Facility | | $3,235.94 | $5,754.40 | $10,232.93 |