- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,148.15 / $5,128.61 / $12,022.64
| Facility | | $1,148.15 | $5,128.61 | $12,022.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $954.99 / $2,041.74 / $3,090.30
| Facility | | $954.99 | $2,041.74 | $3,090.30 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $138.04 / $138.04 / $138.04
| Facility | AS | $138.04 | $138.04 | $138.04 |
- 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
- $2,630.27 / $7,585.78 / $12,022.64
| Facility | | $2,630.27 | $7,585.78 | $12,022.64 |