- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,047.13 / $6,165.95 / $17,782.79
| Facility | | $1,047.13 | $6,165.95 | $17,782.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.67 / $2,238.72 / $2,290.87
| Facility | | $34.67 | $2,238.72 | $2,290.87 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $158.49 / $158.49 / $158.49
| Facility | AS | $158.49 | $158.49 | $158.49 |
- 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
- $2,630.27 / $7,585.78 / $12,022.64
| Facility | | $2,630.27 | $7,585.78 | $12,022.64 |