- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $5,248.07 / $11,220.18
| Facility | | $1,230.27 | $5,248.07 | $11,220.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $616.60 / $1,584.89 / $1,862.09
| Facility | | $616.60 | $1,584.89 | $1,862.09 |
- 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
- $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
- $2,290.87 / $7,585.78 / $11,748.98
| Facility | | $2,290.87 | $7,585.78 | $11,748.98 |