- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,778.28 / $5,370.32 / $7,943.28
| Facility | | $1,778.28 | $5,370.32 | $7,943.28 |
- 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 / $758.58 / $9,772.37
| Facility | | $501.19 | $758.58 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,047.13 / $1,348.96 / $2,511.89
| Professional | | $1,047.13 | $1,348.96 | $2,511.89 |
- Facility/Professional
- Professional
- Modifier
- 22
- Low / Median / High Price
- $3,019.95 / $3,019.95 / $3,801.89
| Professional | 22 | $3,019.95 | $3,019.95 | $3,801.89 |
- Facility/Professional
- Professional
- Modifier
- 52
- Low / Median / High Price
- $870.96 / $870.96 / $1,122.02
| Professional | 52 | $870.96 | $870.96 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- 80
- Low / Median / High Price
- $79.43 / $79.43 / $102.33
| Professional | 80 | $79.43 | $79.43 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- AS
- Low / Median / High Price
- $39.81 / $39.81 / $51.29
| Professional | AS | $39.81 | $39.81 | $51.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $741.31 / $3,311.31 / $10,964.78
| Facility | | $741.31 | $3,311.31 | $10,964.78 |