- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $7,079.46 / $16,595.87
| Facility | | $1,819.70 | $7,079.46 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,148.15 / $1,548.82 / $3,890.45
| Professional | | $1,148.15 | $1,548.82 | $3,890.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,630.78 / $9,772.37 / $18,197.01
| Facility | | $3,630.78 | $9,772.37 | $18,197.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,148.15 / $1,778.28 / $3,311.31
| Professional | | $1,148.15 | $1,778.28 | $3,311.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,548.82 / $3,801.89 / $12,022.64
| Facility | | $1,548.82 | $3,801.89 | $12,022.64 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $194.98 / $194.98 / $194.98
| Facility | AS | $194.98 | $194.98 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,122.02 / $1,949.84 / $4,168.69
| Professional | | $1,122.02 | $1,949.84 | $4,168.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,290.87 / $6,918.31 / $15,488.17
| Facility | | $2,290.87 | $6,918.31 | $15,488.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,047.13 / $1,513.56 / $2,691.53
| Professional | | $1,047.13 | $1,513.56 | $2,691.53 |