- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $870.96 / $4,073.80 / $10,964.78
| Facility | | $870.96 | $4,073.80 | $10,964.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $436.52 / $3,090.30 / $3,630.78
| Facility | | $436.52 | $3,090.30 | $3,630.78 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $169.82 / $169.82 / $169.82
| Facility | AS | $169.82 | $169.82 | $169.82 |
- 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
- $3,311.31 / $10,232.93 / $15,848.93
| Facility | | $3,311.31 | $10,232.93 | $15,848.93 |