- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,274.11 / $5,048.00 / $9,539.00
| Facility | | $2,274.11 | $5,048.00 | $9,539.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,312.32 / $2,001.45 / $5,768.00
| Facility | | $1,312.32 | $2,001.45 | $5,768.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,850.69 / $2,220.83 / $2,739.02
| Professional | | $1,850.69 | $2,220.83 | $2,739.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,850.69 / $2,591.12 / $3,715.08
| Facility | | $1,850.69 | $2,591.12 | $3,715.08 |
- Facility/Professional
- Facility
- Modifier
- 80
- Low / Median / High Price
- $256.80 / $607.38 / $800.87
| Facility | 80 | $256.80 | $607.38 | $800.87 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $179.76 / $425.17 / $560.61
| Facility | AS | $179.76 | $425.17 | $560.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,035.82 / $2,471.00 / $4,807.24
| Facility | | $1,035.82 | $2,471.00 | $4,807.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,547.00 / $3,130.00 / $5,226.00
| Facility | | $1,547.00 | $3,130.00 | $5,226.00 |