- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,047.13 / $5,623.41 / $11,748.98
| Facility | | $1,047.13 | $5,623.41 | $11,748.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $616.60 / $8,912.51 / $9,332.54
| Facility | | $616.60 | $8,912.51 | $9,332.54 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $186.21 / $186.21 / $186.21
| Facility | AS | $186.21 | $186.21 | $186.21 |
- 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 |