- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.83 / $5,011.87 / $12,022.64
| Facility | | $812.83 | $5,011.87 | $12,022.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $489.78 / $3,467.37 / $4,168.69
| Facility | | $489.78 | $3,467.37 | $4,168.69 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $123.03 / $123.03 / $123.03
| Facility | AS | $123.03 | $123.03 | $123.03 |
- 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 |