- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,071.52 / $5,754.40 / $12,589.25
| Facility | | $1,071.52 | $5,754.40 | $12,589.25 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $10,964.78 / $10,964.78 / $10,964.78
| Facility | AS | $10,964.78 | $10,964.78 | $10,964.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,019.95 / $6,760.83 / $14,454.40
| Facility | | $3,019.95 | $6,760.83 | $14,454.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.26 / $2,344.23 / $9,772.37
| Facility | | $1,202.26 | $2,344.23 | $9,772.37 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $125.89 / $125.89 / $125.89
| Facility | AS | $125.89 | $125.89 | $125.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,511.89 / $7,244.36 / $16,595.87
| Facility | | $2,511.89 | $7,244.36 | $16,595.87 |