- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,412.54 / $5,623.41 / $9,549.93
| Facility | | $1,412.54 | $5,623.41 | $9,549.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,318.26 / $3,090.30 / $6,025.60
| Facility | | $1,318.26 | $3,090.30 | $6,025.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,348.96 / $1,513.56 / $2,187.76
| Facility | | $1,348.96 | $1,513.56 | $2,187.76 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $151.36 / $151.36 / $151.36
| Facility | AS | $151.36 | $151.36 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $977.24 / $1,258.93 / $5,011.87
| Professional | | $977.24 | $1,258.93 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- 80
- Low / Median / High Price
- $70.79 / $70.79 / $70.79
| Professional | 80 | $70.79 | $70.79 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- AS
- Low / Median / High Price
- $35.48 / $35.48 / $35.48
| Professional | AS | $35.48 | $35.48 | $35.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $5,623.41 / $8,511.38
| Facility | | $1,513.56 | $5,623.41 | $8,511.38 |