- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,630.27 / $2,630.27 / $2,630.27
| Facility | | $2,630.27 | $2,630.27 | $2,630.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,370.32 / $10,715.19 / $38,018.94
| Facility | | $5,370.32 | $10,715.19 | $38,018.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,165.95 / $8,709.64 / $20,892.96
| Facility | | $6,165.95 | $8,709.64 | $20,892.96 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $446.68 / $446.68 / $446.68
| Facility | AS | $446.68 | $446.68 | $446.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,760.83 / $8,511.38 / $16,595.87
| Facility | | $6,760.83 | $8,511.38 | $16,595.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,951.21 / $3,981.07 / $7,244.36
| Facility | | $2,951.21 | $3,981.07 | $7,244.36 |
- 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 |