- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,905.46 / $1,905.46 / $1,905.46
| Facility | | $1,905.46 | $1,905.46 | $1,905.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,589.25 / $38,904.51 / $83,176.38
| Facility | | $12,589.25 | $38,904.51 | $83,176.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,897.79 / $6,918.31 / $16,595.87
| Facility | | $4,897.79 | $6,918.31 | $16,595.87 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $354.81 / $354.81 / $354.81
| Facility | AS | $354.81 | $354.81 | $354.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,370.32 / $6,760.83 / $12,882.50
| Facility | | $5,370.32 | $6,760.83 | $12,882.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,905.46 / $3,235.94 / $5,248.07
| Facility | | $1,905.46 | $3,235.94 | $5,248.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,445.44 / $3,311.31 / $8,511.38
| Facility | | $1,445.44 | $3,311.31 | $8,511.38 |