- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,762.68 / $12,909.02 / $23,519.74
| Facility | | $8,762.68 | $12,909.02 | $23,519.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,326.84 / $1,493.04 / $2,706.16
| Professional | | $1,326.84 | $1,493.04 | $2,706.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,367.03 / $1,489.57 / $1,622.92
| Facility | | $1,367.03 | $1,489.57 | $1,622.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,257.34 / $1,365.44 / $1,613.70
| Professional | | $1,257.34 | $1,365.44 | $1,613.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,473.31 / $1,473.31 / $1,473.31
| Facility | | $1,473.31 | $1,473.31 | $1,473.31 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $146.63 / $146.63 / $146.63
| Facility | AS | $146.63 | $146.63 | $146.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,231.49 / $1,683.03 / $6,899.79
| Professional | | $1,231.49 | $1,683.03 | $6,899.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,275.45 / $13,145.92 / $20,282.77
| Facility | | $10,275.45 | $13,145.92 | $20,282.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,817.59 / $1,971.24 / $3,064.20
| Professional | | $1,817.59 | $1,971.24 | $3,064.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,030.96 / $1,565.58 / $2,351.55
| Professional | | $1,030.96 | $1,565.58 | $2,351.55 |