- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,380.38 / $5,370.32 / $9,549.93
| Facility | | $1,380.38 | $5,370.32 | $9,549.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,019.95 / $3,019.95 / $7,943.28
| Facility | | $3,019.95 | $3,019.95 | $7,943.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $3,090.30 / $58,884.37
| Facility | | $398.11 | $3,090.30 | $58,884.37 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $39.81 / $39.81 / $39.81
| Facility | AS | $39.81 | $39.81 | $39.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $331.13 / $1,047.13
| Professional | | $234.42 | $331.13 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- 80
- Low / Median / High Price
- $21.38 / $21.38 / $21.38
| Professional | 80 | $21.38 | $21.38 | $21.38 |
- Facility/Professional
- Professional
- Modifier
- AS
- Low / Median / High Price
- $10.72 / $10.72 / $10.72
| Professional | AS | $10.72 | $10.72 | $10.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $213.80 / $1,548.82 / $2,691.53
| Facility | | $213.80 | $1,548.82 | $2,691.53 |