- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,089.30 / $5,370.32 / $7,943.28
| Facility | | $2,089.30 | $5,370.32 | $7,943.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,047.13 / $2,570.40 / $4,677.35
| Facility | | $1,047.13 | $2,570.40 | $4,677.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $776.25 / $1,318.26 / $1,659.59
| Facility | | $776.25 | $1,318.26 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,148.15 / $1,659.59 / $9,332.54
| Professional | | $1,148.15 | $1,659.59 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- 80
- Low / Median / High Price
- $81.28 / $81.28 / $125.89
| Professional | 80 | $81.28 | $81.28 | $125.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,122.02 / $3,981.07 / $6,918.31
| Facility | | $1,122.02 | $3,981.07 | $6,918.31 |