- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,436.42 / $19,508.47 / $19,508.47
| Facility | | $1,436.42 | $19,508.47 | $19,508.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,291.35 / $1,417.94 / $2,264.62
| Professional | | $1,291.35 | $1,417.94 | $2,264.62 |
- Facility/Professional
- Professional
- Modifier
- AS
- Low / Median / High Price
- $100.11 / $180.95 / $388.71
| Professional | AS | $100.11 | $180.95 | $388.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $19,531.91 / $20,229.06 / $20,380.78
| Facility | | $19,531.91 | $20,229.06 | $20,380.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,876.02 / $3,163.76 / $3,709.68
| Professional | | $2,876.02 | $3,163.76 | $3,709.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,737.33 / $3,470.96 / $4,623.33
| Professional | | $1,737.33 | $3,470.96 | $4,623.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,436.42 / $2,020.55 / $4,309.26
| Facility | | $1,436.42 | $2,020.55 | $4,309.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,515.04 / $2,674.51 / $3,711.03
| Professional | | $1,515.04 | $2,674.51 | $3,711.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,515.04 / $2,587.82 / $3,333.09
| Professional | | $1,515.04 | $2,587.82 | $3,333.09 |