- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $446.68 / $5,370.32 / $9,549.93
| Facility | | $446.68 | $5,370.32 | $9,549.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $2,884.03 / $5,495.41
| Facility | | $1,000.00 | $2,884.03 | $5,495.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $457.09 / $457.09 / $2,511.89
| Facility | | $457.09 | $457.09 | $2,511.89 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $45.71 / $45.71 / $45.71
| Facility | AS | $45.71 | $45.71 | $45.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $398.11 / $1,445.44
| Professional | | $275.42 | $398.11 | $1,445.44 |
- Facility/Professional
- Professional
- Modifier
- 80
- Low / Median / High Price
- $24.55 / $24.55 / $24.55
| Professional | 80 | $24.55 | $24.55 | $24.55 |
- Facility/Professional
- Professional
- Modifier
- AS
- Low / Median / High Price
- $12.30 / $12.30 / $12.30
| Professional | AS | $12.30 | $12.30 | $12.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $3,235.94 / $7,943.28
| Facility | | $630.96 | $3,235.94 | $7,943.28 |