- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,754.23 / $2,754.23 / $2,754.23
| Facility | | $2,754.23 | $2,754.23 | $2,754.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,495.41 / $11,220.18 / $38,904.51
| Facility | | $5,495.41 | $11,220.18 | $38,904.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,456.54 / $9,120.11 / $21,877.62
| Facility | | $6,456.54 | $9,120.11 | $21,877.62 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $457.09 / $457.09 / $457.09
| Facility | AS | $457.09 | $457.09 | $457.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,079.46 / $8,709.64 / $16,982.44
| Facility | | $7,079.46 | $8,709.64 | $16,982.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,187.76 / $3,981.07 / $7,585.78
| Facility | | $2,187.76 | $3,981.07 | $7,585.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $3,467.37 / $8,511.38
| Facility | | $1,584.89 | $3,467.37 | $8,511.38 |