- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $6,309.57 / $9,549.93
| Facility | | $1,995.26 | $6,309.57 | $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
- $199.53 / $616.60 / $831.76
| Facility | | $199.53 | $616.60 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,096.48 / $1,445.44 / $2,630.27
| Professional | | $1,096.48 | $1,445.44 | $2,630.27 |
- Facility/Professional
- Professional
- Modifier
- 22
- Low / Median / High Price
- $3,162.28 / $3,162.28 / $3,981.07
| Professional | 22 | $3,162.28 | $3,162.28 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- 80
- Low / Median / High Price
- $83.18 / $83.18 / $107.15
| Professional | 80 | $83.18 | $83.18 | $107.15 |
- Facility/Professional
- Professional
- Modifier
- AS
- Low / Median / High Price
- $41.69 / $41.69 / $53.70
| Professional | AS | $41.69 | $41.69 | $53.70 |
- 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 |