- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $6,918.31 / $30,199.52
| Facility | | $1,230.27 | $6,918.31 | $30,199.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.67 / $14,791.08 / $15,488.17
| Facility | | $34.67 | $14,791.08 | $15,488.17 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $162.18 / $162.18 / $162.18
| Facility | AS | $162.18 | $162.18 | $162.18 |
- 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 / $12,882.50 / $19,054.61
| Facility | | $4,365.16 | $12,882.50 | $19,054.61 |