- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,388.44 / $3,388.44 / $3,388.44
| Facility | | $3,388.44 | $3,388.44 | $3,388.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,760.83 / $13,803.84 / $47,863.01
| Facility | | $6,760.83 | $13,803.84 | $47,863.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,943.28 / $11,220.18 / $26,915.35
| Facility | | $7,943.28 | $11,220.18 | $26,915.35 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $575.44 / $575.44 / $575.44
| Facility | AS | $575.44 | $575.44 | $575.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,709.64 / $10,715.19 / $20,892.96
| Facility | | $8,709.64 | $10,715.19 | $20,892.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,019.95 / $5,370.32 / $8,511.38
| Facility | | $3,019.95 | $5,370.32 | $8,511.38 |
- 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 |