- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,570.88 / $7,413.10 / $15,488.17
| Facility | | $4,570.88 | $7,413.10 | $15,488.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,621.81 / $5,128.61 / $12,022.64
| Facility | | $1,621.81 | $5,128.61 | $12,022.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $512.86 / $4,168.69 / $9,772.37
| Facility | | $512.86 | $4,168.69 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.91 / $190.55 / $977.24
| Professional | | $147.91 | $190.55 | $977.24 |
- Facility/Professional
- Professional
- Modifier
- 80
- Low / Median / High Price
- $11.48 / $11.48 / $14.79
| Professional | 80 | $11.48 | $11.48 | $14.79 |
- Facility/Professional
- Professional
- Modifier
- AS
- Low / Median / High Price
- $5.75 / $5.75 / $7.41
| Professional | AS | $5.75 | $5.75 | $7.41 |
- 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 |