- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,627.96 / $1,627.96 / $1,627.96
| Facility | | $1,627.96 | $1,627.96 | $1,627.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,456.21 / $14,268.42 / $27,270.41
| Facility | | $7,456.21 | $14,268.42 | $27,270.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,019.74 / $5,703.43 / $13,720.37
| Facility | | $4,019.74 | $5,703.43 | $13,720.37 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $199.12 / $199.12 / $199.12
| Facility | AS | $199.12 | $199.12 | $199.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,654.31 / $5,214.30 / $10,803.44
| Facility | | $3,654.31 | $5,214.30 | $10,803.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,761.75 / $2,879.38 / $5,913.00
| Facility | | $1,761.75 | $2,879.38 | $5,913.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $429.59 / $429.59 / $429.59
| Facility | AS | $429.59 | $429.59 | $429.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,457.00 / $9,370.00 / $12,774.00
| Facility | | $5,457.00 | $9,370.00 | $12,774.00 |