- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,150.84 / $7,872.84 / $15,287.40
| Facility | | $7,150.84 | $7,872.84 | $15,287.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,835.87 / $16,845.77 / $27,473.25
| Facility | | $6,835.87 | $16,845.77 | $27,473.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $686.68 / $686.68 / $686.68
| Facility | | $686.68 | $686.68 | $686.68 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $67.78 / $67.78 / $67.78
| Facility | AS | $67.78 | $67.78 | $67.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $552.36 / $703.01 / $908.86
| Facility | | $552.36 | $703.01 | $908.86 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $67.78 / $67.78 / $67.78
| Facility | AS | $67.78 | $67.78 | $67.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,002.00 / $15,131.00 / $16,269.00
| Facility | | $2,002.00 | $15,131.00 | $16,269.00 |