- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,365.16 / $9,332.54 / $15,488.17
| Facility | | $4,365.16 | $9,332.54 | $15,488.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.96 / $5,370.32 / $14,454.40
| Facility | | $2,137.96 | $5,370.32 | $14,454.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,011.87 / $7,244.36 / $10,000.00
| Facility | | $5,011.87 | $7,244.36 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $851.14 / $1,071.52 / $2,691.53
| Professional | | $851.14 | $1,071.52 | $2,691.53 |
- Facility/Professional
- Professional
- Modifier
- 80
- Low / Median / High Price
- $61.66 / $61.66 / $61.66
| Professional | 80 | $61.66 | $61.66 | $61.66 |
- Facility/Professional
- Professional
- Modifier
- AS
- Low / Median / High Price
- $30.90 / $30.90 / $30.90
| Professional | AS | $30.90 | $30.90 | $30.90 |
- 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 |