- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,089.30 / $7,079.46 / $13,803.84
| Facility | | $2,089.30 | $7,079.46 | $13,803.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $933.25 / $3,388.44 / $8,709.64
| Facility | | $933.25 | $3,388.44 | $8,709.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $616.60 / $3,467.37 / $9,772.37
| Facility | | $616.60 | $3,467.37 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $478.63 / $2,290.87
| Professional | | $371.54 | $478.63 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- 80
- Low / Median / High Price
- $28.18 / $28.18 / $35.48
| Professional | 80 | $28.18 | $28.18 | $35.48 |
- Facility/Professional
- Professional
- Modifier
- AS
- Low / Median / High Price
- $13.80 / $13.80 / $17.78
| Professional | AS | $13.80 | $13.80 | $17.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $741.31 / $5,370.32 / $10,964.78
| Facility | | $741.31 | $5,370.32 | $10,964.78 |