- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,838.38 / $7,838.38 / $7,838.38
| Facility | | $7,838.38 | $7,838.38 | $7,838.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,349.67 / $14,108.40 / $22,319.96
| Facility | | $11,349.67 | $14,108.40 | $22,319.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $470.38 / $470.38 / $3,388.59
| Facility | | $470.38 | $470.38 | $3,388.59 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $46.23 / $46.23 / $46.23
| Facility | AS | $46.23 | $46.23 | $46.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $393.25 / $470.38 / $639.25
| Facility | | $393.25 | $470.38 | $639.25 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $46.23 / $46.23 / $46.23
| Facility | AS | $46.23 | $46.23 | $46.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,983.00 / $2,983.00 / $8,842.00
| Facility | | $2,983.00 | $2,983.00 | $8,842.00 |