- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,380.38 / $6,309.57 / $25,118.86
| Facility | | $1,380.38 | $6,309.57 | $25,118.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $12,589.25 / $53,703.18
| Facility | | $398.11 | $12,589.25 | $53,703.18 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $269.15 / $269.15 / $269.15
| Facility | AS | $269.15 | $269.15 | $269.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,332.54 / $20,892.96 / $33,113.11
| Facility | | $9,332.54 | $20,892.96 | $33,113.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,165.95 / $16,595.87 / $34,673.69
| Facility | | $6,165.95 | $16,595.87 | $34,673.69 |