- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,047.13 / $5,888.44 / $13,803.84
| Facility | | $1,047.13 | $5,888.44 | $13,803.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $691.83 / $4,570.88 / $4,677.35
| Facility | | $691.83 | $4,570.88 | $4,677.35 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $134.90 / $134.90 / $134.90
| Facility | AS | $134.90 | $134.90 | $134.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,165.95 / $12,022.64 / $22,908.68
| Facility | | $6,165.95 | $12,022.64 | $22,908.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,365.16 / $12,302.69 / $18,620.87
| Facility | | $4,365.16 | $12,302.69 | $18,620.87 |