- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $389.05 / $3,235.94 / $8,709.64
| Facility | | $389.05 | $3,235.94 | $8,709.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $436.52 / $1,584.89 / $1,659.59
| Facility | | $436.52 | $1,584.89 | $1,659.59 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $60.26 / $60.26 / $60.26
| Facility | AS | $60.26 | $60.26 | $60.26 |
- 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
- $1,905.46 / $5,623.41 / $9,772.37
| Facility | | $1,905.46 | $5,623.41 | $9,772.37 |