- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,162.28 / $5,495.41 / $7,413.10
| Facility | | $3,162.28 | $5,495.41 | $7,413.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,187.76 / $5,370.32 / $11,220.18
| Facility | | $2,187.76 | $5,370.32 | $11,220.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.83 / $3,467.37 / $6,606.93
| Facility | | $812.83 | $3,467.37 | $6,606.93 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $81.28 / $81.28 / $81.28
| Facility | AS | $81.28 | $81.28 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $501.19 / $776.25 / $3,981.07
| Professional | | $501.19 | $776.25 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- 80
- Low / Median / High Price
- $37.15 / $37.15 / $52.48
| Professional | 80 | $37.15 | $37.15 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- AS
- Low / Median / High Price
- $18.62 / $18.62 / $26.30
| Professional | AS | $18.62 | $18.62 | $26.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $7,413.10 / $17,378.01
| Facility | | $1,995.26 | $7,413.10 | $17,378.01 |