- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,621.81 / $5,888.44 / $9,549.93
| Facility | | $1,621.81 | $5,888.44 | $9,549.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $3,090.30 / $6,025.60
| Facility | | $1,230.27 | $3,090.30 | $6,025.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,348.96 / $1,905.46 / $2,187.76
| Facility | | $1,348.96 | $1,905.46 | $2,187.76 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $134.90 / $134.90 / $134.90
| Facility | AS | $134.90 | $134.90 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $831.76 / $1,174.90 / $4,570.88
| Professional | | $831.76 | $1,174.90 | $4,570.88 |
- Facility/Professional
- Professional
- Modifier
- 80
- Low / Median / High Price
- $63.10 / $63.10 / $63.10
| Professional | 80 | $63.10 | $63.10 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- AS
- Low / Median / High Price
- $31.62 / $31.62 / $31.62
| Professional | AS | $31.62 | $31.62 | $31.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,737.80 / $6,456.54 / $12,022.64
| Facility | | $1,737.80 | $6,456.54 | $12,022.64 |