- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,659.59 / $1,659.59 / $1,659.59
| Facility | | $1,659.59 | $1,659.59 | $1,659.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,762.47 / $13,489.63 / $37,153.52
| Facility | | $7,762.47 | $13,489.63 | $37,153.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,890.45 / $5,495.41 / $13,182.57
| Facility | | $3,890.45 | $5,495.41 | $13,182.57 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $281.84 / $281.84 / $281.84
| Facility | AS | $281.84 | $281.84 | $281.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,168.69 / $5,248.07 / $10,232.93
| Facility | | $4,168.69 | $5,248.07 | $10,232.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,041.74 / $3,019.95 / $4,466.84
| Facility | | $2,041.74 | $3,019.95 | $4,466.84 |
- 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 |