- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,621.81 / $5,370.32 / $9,549.93
| Facility | | $1,621.81 | $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
- $1,000.00 / $1,318.26 / $2,454.71
| Professional | | $1,000.00 | $1,318.26 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- 80
- Low / Median / High Price
- $77.62 / $77.62 / $100.00
| Professional | 80 | $77.62 | $77.62 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- AS
- Low / Median / High Price
- $38.90 / $38.90 / $50.12
| Professional | AS | $38.90 | $38.90 | $50.12 |
- 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 |