- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,168.69 / $10,964.78 / $16,595.87
| Facility | | $4,168.69 | $10,964.78 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,174.90 / $1,698.24 / $3,548.13
| Professional | | $1,174.90 | $1,698.24 | $3,548.13 |
- Facility/Professional
- Professional
- Modifier
- AS
- Low / Median / High Price
- $85.11 / $331.13 / $467.74
| Professional | AS | $85.11 | $331.13 | $467.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,197.01 / $18,197.01 / $18,620.87
| Facility | | $18,197.01 | $18,197.01 | $18,620.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,290.87 / $2,818.38 / $3,311.31
| Professional | | $2,290.87 | $2,818.38 | $3,311.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,621.81 / $2,398.83 / $3,890.45
| Professional | | $1,621.81 | $2,398.83 | $3,890.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,348.96 / $5,888.44 / $18,620.87
| Facility | | $1,348.96 | $5,888.44 | $18,620.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,548.82 / $2,511.89 / $3,630.78
| Professional | | $1,548.82 | $2,511.89 | $3,630.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $2,041.74 / $24,547.09
| Facility | | $1,819.70 | $2,041.74 | $24,547.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,479.11 / $2,398.83 / $3,162.28
| Professional | | $1,479.11 | $2,398.83 | $3,162.28 |