- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,907.06 / $1,907.06 / $1,907.06
| Facility | | $1,907.06 | $1,907.06 | $1,907.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,194.24 / $32,650.90 / $66,228.75
| Facility | | $9,194.24 | $32,650.90 | $66,228.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,708.35 / $6,680.48 / $16,070.79
| Facility | | $4,708.35 | $6,680.48 | $16,070.79 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $238.75 / $238.75 / $238.75
| Facility | AS | $238.75 | $238.75 | $238.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,280.32 / $6,107.56 / $12,654.16
| Facility | | $4,280.32 | $6,107.56 | $12,654.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,920.34 / $3,222.93 / $5,276.20
| Facility | | $1,920.34 | $3,222.93 | $5,276.20 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $502.82 / $502.82 / $502.82
| Facility | AS | $502.82 | $502.82 | $502.82 |
- 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 |