- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,047.13 / $5,888.44 / $12,022.64
| Facility | | $1,047.13 | $5,888.44 | $12,022.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $616.60 / $4,786.30 / $4,897.79
| Facility | | $616.60 | $4,786.30 | $4,897.79 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $97.72 / $97.72 / $97.72
| Facility | AS | $97.72 | $97.72 | $97.72 |
- 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 / $5,754.40 / $9,772.37
| Facility | | $1,905.46 | $5,754.40 | $9,772.37 |