- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $245.47 / $5,370.32 / $9,549.93
| Facility | | $245.47 | $5,370.32 | $9,549.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $645.65 / $2,754.23 / $6,606.93
| Facility | | $645.65 | $2,754.23 | $6,606.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $199.53 / $616.60 / $831.76
| Facility | | $199.53 | $616.60 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.83 / $169.82 / $812.83
| Professional | | $131.83 | $169.82 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- 80
- Low / Median / High Price
- $10.47 / $10.47 / $13.18
| Professional | 80 | $10.47 | $10.47 | $13.18 |
- Facility/Professional
- Professional
- Modifier
- AS
- Low / Median / High Price
- $5.13 / $5.13 / $6.61
| Professional | AS | $5.13 | $5.13 | $6.61 |
- 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 |