- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,398.83 / $2,398.83 / $2,398.83
| Facility | | $2,398.83 | $2,398.83 | $2,398.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,786.30 / $9,772.37 / $33,884.42
| Facility | | $4,786.30 | $9,772.37 | $33,884.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,623.41 / $7,943.28 / $19,054.61
| Facility | | $5,623.41 | $7,943.28 | $19,054.61 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $398.11 / $398.11 / $398.11
| Facility | AS | $398.11 | $398.11 | $398.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,165.95 / $7,585.78 / $14,791.08
| Facility | | $6,165.95 | $7,585.78 | $14,791.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,691.53 / $3,801.89 / $6,606.93
| Facility | | $2,691.53 | $3,801.89 | $6,606.93 |
- 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 |