- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $5,128.61 / $10,715.19
| Facility | | $1,096.48 | $5,128.61 | $10,715.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $616.60 / $1,584.89 / $2,290.87
| Facility | | $616.60 | $1,584.89 | $2,290.87 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $125.89 / $125.89 / $125.89
| Facility | AS | $125.89 | $125.89 | $125.89 |
- 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 |