- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $5,370.32 / $9,549.93
| Facility | | $1,698.24 | $5,370.32 | $9,549.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $3,162.28 / $6,760.83
| Facility | | $851.14 | $3,162.28 | $6,760.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $199.53 / $588.84 / $831.76
| Facility | | $199.53 | $588.84 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,288.25 / $1,698.24 / $3,090.30
| Professional | | $1,288.25 | $1,698.24 | $3,090.30 |
- Facility/Professional
- Professional
- Modifier
- 80
- Low / Median / High Price
- $100.00 / $100.00 / $128.82
| Professional | 80 | $100.00 | $100.00 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- AS
- Low / Median / High Price
- $50.12 / $50.12 / $64.57
| Professional | AS | $50.12 | $50.12 | $64.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $2,511.89 / $7,079.46
| Facility | | $398.11 | $2,511.89 | $7,079.46 |