- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,071.52 / $3,388.44 / $7,413.10
| Facility | | $1,071.52 | $3,388.44 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.78 / $416.87 / $891.25
| Professional | | $173.78 | $416.87 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.83 / $288.40 / $630.96
| Professional | | $177.83 | $288.40 | $630.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.26 / $5,128.61 / $14,791.08
| Facility | | $1,202.26 | $5,128.61 | $14,791.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.52 / $645.65 / $912.01
| Professional | | $436.52 | $645.65 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $7,244.36 / $36,307.81
| Facility | | $851.14 | $7,244.36 | $36,307.81 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $57.54 / $57.54 / $57.54
| Facility | AS | $57.54 | $57.54 | $57.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.05 / $575.44 / $1,047.13
| Professional | | $389.05 | $575.44 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $524.81 / $1,995.26
| Professional | | $363.08 | $524.81 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- 80
- Low / Median / High Price
- $30.90 / $30.90 / $30.90
| Professional | 80 | $30.90 | $30.90 | $30.90 |
- Facility/Professional
- Professional
- Modifier
- AS
- Low / Median / High Price
- $15.49 / $15.49 / $15.49
| Professional | AS | $15.49 | $15.49 | $15.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,090.30 / $12,302.69 / $45,708.82
| Facility | | $3,090.30 | $12,302.69 | $45,708.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.23 / $524.81 / $891.25
| Professional | | $316.23 | $524.81 | $891.25 |