- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $954.99 / $4,786.30 / $12,022.64
| Facility | | $954.99 | $4,786.30 | $12,022.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $489.78 / $4,466.84 / $5,248.07
| Facility | | $489.78 | $4,466.84 | $5,248.07 |
- 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 / $7,762.47 / $12,022.64
| Facility | | $2,630.27 | $7,762.47 | $12,022.64 |