- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,549.93 / $15,135.61 / $33,884.42
| Facility | | $9,549.93 | $15,135.61 | $33,884.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,230.27 / $1,778.28 / $3,801.89
| Professional | | $1,230.27 | $1,778.28 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- AS
- Low / Median / High Price
- $169.82 / $380.19 / $2,818.38
| Professional | AS | $169.82 | $380.19 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,162.28 / $4,466.84 / $5,495.41
| Professional | | $3,162.28 | $4,466.84 | $5,495.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,548.82 / $11,220.18 / $33,113.11
| Facility | | $1,548.82 | $11,220.18 | $33,113.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,698.24 / $3,715.35 / $6,918.31
| Professional | | $1,698.24 | $3,715.35 | $6,918.31 |
- Facility/Professional
- Professional
- Modifier
- AS
- Low / Median / High Price
- $213.80 / $446.68 / $2,818.38
| Professional | AS | $213.80 | $446.68 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,265.80 / $5,248.07 / $7,762.47
| Professional | | $4,265.80 | $5,248.07 | $7,762.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.26 / $2,187.76 / $6,918.31
| Facility | | $1,202.26 | $2,187.76 | $6,918.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.26 / $1,862.09 / $4,466.84
| Professional | | $60.26 | $1,862.09 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,479.11 / $6,309.57 / $11,220.18
| Professional | | $1,479.11 | $6,309.57 | $11,220.18 |