- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.83 / $9,332.54 / $9,332.54
| Facility | | $812.83 | $9,332.54 | $9,332.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $933.25 / $933.25 / $1,174.90
| Facility | | $933.25 | $933.25 | $1,174.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $1,513.56 / $1,862.09
| Facility | | $1,513.56 | $1,513.56 | $1,862.09 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $151.36 / $151.36 / $151.36
| Facility | AS | $151.36 | $151.36 | $151.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,791.08 / $14,791.08 / $32,359.37
| Facility | | $14,791.08 | $14,791.08 | $32,359.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34,673.69 / $34,673.69 / $87,096.36
| Facility | | $34,673.69 | $34,673.69 | $87,096.36 |