- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,235.94 / $3,235.94 / $11,481.54
| Facility | | $3,235.94 | $3,235.94 | $11,481.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,456.54 / $13,182.57 / $46,773.51
| Facility | | $6,456.54 | $13,182.57 | $46,773.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,585.78 / $10,715.19 / $25,118.86
| Facility | | $7,585.78 | $10,715.19 | $25,118.86 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $537.03 / $537.03 / $537.03
| Facility | AS | $537.03 | $537.03 | $537.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,128.31 / $10,232.93 / $19,952.62
| Facility | | $8,128.31 | $10,232.93 | $19,952.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,019.95 / $5,128.61 / $8,128.31
| Facility | | $3,019.95 | $5,128.61 | $8,128.31 |
- 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 |