- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $4,786.30 / $12,882.50
| Facility | | $1,023.29 | $4,786.30 | $12,882.50 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $21,379.62 / $21,379.62 / $21,379.62
| Facility | AS | $21,379.62 | $21,379.62 | $21,379.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,162.28 / $6,918.31 / $20,417.38
| Facility | | $3,162.28 | $6,918.31 | $20,417.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $870.96 / $1,949.84 / $5,754.40
| Facility | | $870.96 | $1,949.84 | $5,754.40 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $128.82 / $128.82 / $128.82
| Facility | AS | $128.82 | $128.82 | $128.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $7,244.36 / $16,982.44
| Facility | | $2,454.71 | $7,244.36 | $16,982.44 |