- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,288.25 / $5,370.32 / $9,549.93
| Facility | | $1,288.25 | $5,370.32 | $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 / $1,513.56 / $2,511.89
| Facility | | $501.19 | $1,513.56 | $2,511.89 |
- 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
- $933.25 / $1,202.26 / $5,011.87
| Professional | | $933.25 | $1,202.26 | $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
- $34.67 / $34.67 / $34.67
| Professional | AS | $34.67 | $34.67 | $34.67 |
- 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 |