- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,047.13 / $1,047.13 / $30,902.95
| Facility | | $1,047.13 | $1,047.13 | $30,902.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,606.93 / $15,848.93 / $32,359.37
| Facility | | $6,606.93 | $15,848.93 | $32,359.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,754.23 / $3,890.45 / $9,120.11
| Facility | | $2,754.23 | $3,890.45 | $9,120.11 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $190.55 / $190.55 / $190.55
| Facility | AS | $190.55 | $190.55 | $190.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,951.21 / $3,715.35 / $7,244.36
| Facility | | $2,951.21 | $3,715.35 | $7,244.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,122.02 / $1,862.09 / $3,235.94
| Facility | | $1,122.02 | $1,862.09 | $3,235.94 |
- 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 |