- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $3,162.28 / $6,165.95
| Facility | | $1,096.48 | $3,162.28 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.28 / $234.42 / $1,584.89
| Professional | | $81.28 | $234.42 | $1,584.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.55 / $1,513.56 / $2,691.53
| Professional | | $190.55 | $1,513.56 | $2,691.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $114.82 / $851.14 / $2,454.71
| Facility | | $114.82 | $851.14 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,174.90 / $2,754.23 / $6,760.83
| Professional | | $1,174.90 | $2,754.23 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.55 / $208.93 / $2,818.38
| Professional | | $190.55 | $208.93 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.55 / $190.55 / $2,398.83
| Professional | | $190.55 | $190.55 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.25 / $1,288.25 / $1,995.26
| Professional | | $141.25 | $1,288.25 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- 80
- Low / Median / High Price
- $478.63 / $478.63 / $478.63
| Professional | 80 | $478.63 | $478.63 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- AS
- Low / Median / High Price
- $478.63 / $478.63 / $478.63
| Professional | AS | $478.63 | $478.63 | $478.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.83 / $812.83 / $812.83
| Facility | | $812.83 | $812.83 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.65 / $275.42 / $3,019.95
| Professional | | $109.65 | $275.42 | $3,019.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.78 / $213.80 / $2,187.76
| Professional | | $173.78 | $213.80 | $2,187.76 |