- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,815.30 / $1,815.30 / $1,815.30
| Facility | | $1,815.30 | $1,815.30 | $1,815.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,093.57 / $32,422.94 / $66,228.75
| Facility | | $9,093.57 | $32,422.94 | $66,228.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,481.06 / $6,357.98 / $15,294.98
| Facility | | $4,481.06 | $6,357.98 | $15,294.98 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $218.70 / $218.70 / $218.70
| Facility | AS | $218.70 | $218.70 | $218.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,073.69 / $5,812.72 / $12,043.29
| Facility | | $4,073.69 | $5,812.72 | $12,043.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,886.54 / $3,067.86 / $5,030.66
| Facility | | $1,886.54 | $3,067.86 | $5,030.66 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $479.24 / $479.24 / $479.24
| Facility | AS | $479.24 | $479.24 | $479.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,356.00 / $2,260.00 / $5,530.00
| Facility | | $1,356.00 | $2,260.00 | $5,530.00 |