- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,047.13 / $6,025.60 / $13,182.57
| Facility | | $1,047.13 | $6,025.60 | $13,182.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $1,122.02 / $6,760.83
| Facility | | $398.11 | $1,122.02 | $6,760.83 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $112.20 / $112.20 / $112.20
| Facility | AS | $112.20 | $112.20 | $112.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,495.41 / $11,748.98 / $22,908.68
| Facility | | $5,495.41 | $11,748.98 | $22,908.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,715.35 / $11,748.98 / $18,620.87
| Facility | | $3,715.35 | $11,748.98 | $18,620.87 |