- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,754.40 / $7,943.28 / $41,686.94
| Facility | | $5,754.40 | $7,943.28 | $41,686.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $23,442.29 / $30,199.52 / $58,884.37
| Facility | | $23,442.29 | $30,199.52 | $58,884.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $794.33 / $1,737.80 / $33,884.42
| Facility | | $794.33 | $1,737.80 | $33,884.42 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $9,332.54 / $9,332.54 / $9,332.54
| Facility | AS | $9,332.54 | $9,332.54 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,778.28 / $1,905.46 / $2,454.71
| Professional | | $1,778.28 | $1,905.46 | $2,454.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,715.19 / $17,782.79 / $27,542.29
| Facility | | $10,715.19 | $17,782.79 | $27,542.29 |