- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,025.39 / $1,025.39 / $16,811.59
| Professional | | $1,025.39 | $1,025.39 | $16,811.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,992.79 / $9,992.00 / $19,050.00
| Facility | | $8,992.79 | $9,992.00 | $19,050.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $727.56 / $1,397.97 / $16,322.46
| Professional | | $727.56 | $1,397.97 | $16,322.46 |
- Facility/Professional
- Professional
- Modifier
- 80
- Low / Median / High Price
- $116.40 / $223.67 / $2,611.59
| Professional | 80 | $116.40 | $223.67 | $2,611.59 |
- Facility/Professional
- Professional
- Modifier
- AS
- Low / Median / High Price
- $101.85 / $195.71 / $2,285.14
| Professional | AS | $101.85 | $195.71 | $2,285.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14,997.82 / $22,097.12 / $43,482.94
| Professional | | $14,997.82 | $22,097.12 | $43,482.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $468.25 / $595.20 / $9,261.28
| Professional | | $468.25 | $595.20 | $9,261.28 |