- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,635.88 / $1,635.88 / $1,635.88
| Facility | | $1,635.88 | $1,635.88 | $1,635.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,378.87 / $32,422.94 / $66,228.75
| Facility | | $8,378.87 | $32,422.94 | $66,228.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,038.26 / $5,729.70 / $13,783.58
| Facility | | $4,038.26 | $5,729.70 | $13,783.58 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $202.96 / $202.96 / $202.96
| Facility | AS | $202.96 | $202.96 | $202.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,671.14 / $5,238.32 / $10,853.21
| Facility | | $3,671.14 | $5,238.32 | $10,853.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,718.86 / $2,812.68 / $4,531.54
| Facility | | $1,718.86 | $2,812.68 | $4,531.54 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $431.50 / $431.50 / $431.50
| Facility | AS | $431.50 | $431.50 | $431.50 |
- 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 |