- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $144.54 / $5,370.32 / $9,549.93
| Facility | | $144.54 | $5,370.32 | $9,549.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,943.28 / $7,943.28 / $7,943.28
| Facility | | $7,943.28 | $7,943.28 | $7,943.28 |
- 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
- $77.62 / $100.00 / $457.09
| Professional | | $77.62 | $100.00 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- 80
- Low / Median / High Price
- $6.17 / $6.17 / $7.76
| Professional | 80 | $6.17 | $6.17 | $7.76 |
- Facility/Professional
- Professional
- Modifier
- AS
- Low / Median / High Price
- $3.09 / $3.09 / $3.89
| Professional | AS | $3.09 | $3.09 | $3.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $81.28 / $1,230.27 / $2,344.23
| Facility | | $81.28 | $1,230.27 | $2,344.23 |