- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,511.89 / $7,943.28 / $14,454.40
| Facility | | $2,511.89 | $7,943.28 | $14,454.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20,892.96 / $27,542.29 / $53,703.18
| Facility | | $20,892.96 | $27,542.29 | $53,703.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $2,238.72 / $24,547.09
| Facility | | $1,513.56 | $2,238.72 | $24,547.09 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $616.60 / $616.60 / $616.60
| Facility | AS | $616.60 | $616.60 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,951.21 / $3,019.95 / $4,168.69
| Professional | | $2,951.21 | $3,019.95 | $4,168.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,235.94 / $4,570.88 / $13,803.84
| Facility | | $3,235.94 | $4,570.88 | $13,803.84 |