- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,174.90 / $1,174.90 / $6,760.83
| Facility | | $1,174.90 | $1,174.90 | $6,760.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,019.95 / $13,803.84 / $32,359.37
| Facility | | $3,019.95 | $13,803.84 | $32,359.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,388.44 / $4,365.16 / $10,232.93
| Facility | | $3,388.44 | $4,365.16 | $10,232.93 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $218.78 / $218.78 / $218.78
| Facility | AS | $218.78 | $218.78 | $218.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,388.44 / $4,786.30 / $8,128.31
| Facility | | $3,388.44 | $4,786.30 | $8,128.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,258.93 / $2,398.83 / $10,715.19
| Facility | | $1,258.93 | $2,398.83 | $10,715.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,570.88 / $9,332.54 / $13,182.57
| Facility | | $4,570.88 | $9,332.54 | $13,182.57 |