- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,348.96 / $5,128.61 / $7,413.10
| Facility | | $1,348.96 | $5,128.61 | $7,413.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,258.93 / $4,265.80 / $12,022.64
| Facility | | $1,258.93 | $4,265.80 | $12,022.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,905.46 / $11,481.54
| Facility | | $1,000.00 | $1,905.46 | $11,481.54 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $190.55 / $190.55 / $190.55
| Facility | AS | $190.55 | $190.55 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,122.02 / $1,318.26 / $6,165.95
| Professional | | $1,122.02 | $1,318.26 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- 80
- Low / Median / High Price
- $89.13 / $89.13 / $89.13
| Professional | 80 | $89.13 | $89.13 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- AS
- Low / Median / High Price
- $44.67 / $44.67 / $44.67
| Professional | AS | $44.67 | $44.67 | $44.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $5,754.40 / $8,511.38
| Facility | | $1,513.56 | $5,754.40 | $8,511.38 |