- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,365.16 / $8,709.64 / $14,791.08
| Facility | | $4,365.16 | $8,709.64 | $14,791.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $5,011.87 / $12,882.50
| Facility | | $1,819.70 | $5,011.87 | $12,882.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,168.69 / $7,244.36 / $10,000.00
| Facility | | $4,168.69 | $7,244.36 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.78 / $616.60 / $2,041.74
| Professional | | $489.78 | $616.60 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- 80
- Low / Median / High Price
- $35.48 / $35.48 / $35.48
| Professional | 80 | $35.48 | $35.48 | $35.48 |
- Facility/Professional
- Professional
- Modifier
- AS
- Low / Median / High Price
- $17.78 / $17.78 / $17.78
| Professional | AS | $17.78 | $17.78 | $17.78 |
- 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 |