- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,047.13 / $5,495.41 / $12,022.64
| Facility | | $1,047.13 | $5,495.41 | $12,022.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $616.60 / $3,467.37 / $3,630.78
| Facility | | $616.60 | $3,467.37 | $3,630.78 |
- 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
- $3,311.31 / $10,232.93 / $15,848.93
| Facility | | $3,311.31 | $10,232.93 | $15,848.93 |