- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,737.80 / $6,309.57 / $9,549.93
| Facility | | $1,737.80 | $6,309.57 | $9,549.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $3,162.28 / $6,025.60
| Facility | | $1,230.27 | $3,162.28 | $6,025.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $2,344.23 / $2,511.89
| Facility | | $501.19 | $2,344.23 | $2,511.89 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $234.42 / $234.42 / $234.42
| Facility | AS | $234.42 | $234.42 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,479.11 / $1,862.09 / $7,585.78
| Professional | | $1,479.11 | $1,862.09 | $7,585.78 |
- Facility/Professional
- Professional
- Modifier
- 80
- Low / Median / High Price
- $107.15 / $107.15 / $107.15
| Professional | 80 | $107.15 | $107.15 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- AS
- Low / Median / High Price
- $53.70 / $53.70 / $53.70
| Professional | AS | $53.70 | $53.70 | $53.70 |
- 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 |