- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,581.01 / $1,581.01 / $1,581.01
| Facility | | $1,581.01 | $1,581.01 | $1,581.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,247.72 / $14,220.25 / $26,507.86
| Facility | | $7,247.72 | $14,220.25 | $26,507.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,895.99 / $5,527.85 / $13,297.98
| Facility | | $3,895.99 | $5,527.85 | $13,297.98 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $190.74 / $190.74 / $190.74
| Facility | AS | $190.74 | $190.74 | $190.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,541.81 / $5,053.78 / $10,470.85
| Facility | | $3,541.81 | $5,053.78 | $10,470.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,646.00 / $2,716.92 / $4,377.26
| Facility | | $1,646.00 | $2,716.92 | $4,377.26 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $416.31 / $416.31 / $416.31
| Facility | AS | $416.31 | $416.31 | $416.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,720.00 / $3,500.00 / $8,152.00
| Facility | | $1,720.00 | $3,500.00 | $8,152.00 |