- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,630.78 / $6,760.83 / $19,952.62
| Facility | | $3,630.78 | $6,760.83 | $19,952.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,187.76 / $5,888.44 / $23,988.33
| Facility | | $2,187.76 | $5,888.44 | $23,988.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $2,511.89 / $3,548.13
| Facility | | $501.19 | $2,511.89 | $3,548.13 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $354.81 / $354.81 / $354.81
| Facility | AS | $354.81 | $354.81 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,187.76 / $3,235.94 / $11,748.98
| Professional | | $2,187.76 | $3,235.94 | $11,748.98 |
- Facility/Professional
- Professional
- Modifier
- 80
- Low / Median / High Price
- $165.96 / $165.96 / $165.96
| Professional | 80 | $165.96 | $165.96 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- AS
- Low / Median / High Price
- $83.18 / $83.18 / $83.18
| Professional | AS | $83.18 | $83.18 | $83.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,290.87 / $8,912.51 / $19,498.45
| Facility | | $2,290.87 | $8,912.51 | $19,498.45 |