- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,019.95 / $7,413.10 / $15,488.17
| Facility | | $3,019.95 | $7,413.10 | $15,488.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,071.52 / $3,630.78 / $8,511.38
| Facility | | $1,071.52 | $3,630.78 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $199.53 / $616.60 / $1,230.27
| Facility | | $199.53 | $616.60 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,698.24 / $2,187.76 / $4,466.84
| Professional | | $1,698.24 | $2,187.76 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- 22
- Low / Median / High Price
- $5,011.87 / $5,011.87 / $6,309.57
| Professional | 22 | $5,011.87 | $5,011.87 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- 80
- Low / Median / High Price
- $131.83 / $131.83 / $169.82
| Professional | 80 | $131.83 | $131.83 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- AS
- Low / Median / High Price
- $66.07 / $66.07 / $85.11
| Professional | AS | $66.07 | $66.07 | $85.11 |
- 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 |