- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,089.30 / $5,623.41 / $9,549.93
| Facility | | $2,089.30 | $5,623.41 | $9,549.93 |
- 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
- $2,041.74 / $2,238.72 / $58,884.37
| Facility | | $2,041.74 | $2,238.72 | $58,884.37 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $204.17 / $204.17 / $204.17
| Facility | AS | $204.17 | $204.17 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,318.26 / $1,905.46 / $6,606.93
| Professional | | $1,318.26 | $1,905.46 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- 80
- Low / Median / High Price
- $112.20 / $112.20 / $112.20
| Professional | 80 | $112.20 | $112.20 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- AS
- Low / Median / High Price
- $56.23 / $56.23 / $56.23
| Professional | AS | $56.23 | $56.23 | $56.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $7,762.47 / $17,378.01
| Facility | | $1,995.26 | $7,762.47 | $17,378.01 |