- 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
- $501.19 / $616.60 / $831.76
| Facility | | $501.19 | $616.60 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,148.15 / $1,513.56 / $2,818.38
| Professional | | $1,148.15 | $1,513.56 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- 22
- Low / Median / High Price
- $3,311.31 / $3,311.31 / $4,265.80
| Professional | 22 | $3,311.31 | $3,311.31 | $4,265.80 |
- Facility/Professional
- Professional
- Modifier
- 80
- Low / Median / High Price
- $89.13 / $89.13 / $112.20
| Professional | 80 | $89.13 | $89.13 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- AS
- Low / Median / High Price
- $44.67 / $44.67 / $56.23
| Professional | AS | $44.67 | $44.67 | $56.23 |
- 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 |