- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,388.44 / $6,760.83 / $19,952.62
| Facility | | $3,388.44 | $6,760.83 | $19,952.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $3,801.89 / $23,988.33
| Facility | | $1,230.27 | $3,801.89 | $23,988.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,511.89 / $6,918.31 / $9,772.37
| Facility | | $2,511.89 | $6,918.31 | $9,772.37 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $257.04 / $257.04 / $257.04
| Facility | AS | $257.04 | $257.04 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,698.24 / $2,511.89 / $8,317.64
| Professional | | $1,698.24 | $2,511.89 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- 80
- Low / Median / High Price
- $123.03 / $123.03 / $123.03
| Professional | 80 | $123.03 | $123.03 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- AS
- Low / Median / High Price
- $61.66 / $61.66 / $61.66
| Professional | AS | $61.66 | $61.66 | $61.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,290.87 / $8,912.51 / $23,988.33
| Facility | | $2,290.87 | $8,912.51 | $23,988.33 |