- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,162.28 / $5,623.41 / $7,413.10
| Facility | | $3,162.28 | $5,623.41 | $7,413.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,380.38 / $3,801.89 / $6,918.31
| Facility | | $1,380.38 | $3,801.89 | $6,918.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $776.25 / $3,235.94 / $4,073.80
| Facility | | $776.25 | $3,235.94 | $4,073.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $977.24 / $1,445.44 / $7,943.28
| Professional | | $977.24 | $1,445.44 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- 80
- Low / Median / High Price
- $69.18 / $69.18 / $107.15
| Professional | 80 | $69.18 | $69.18 | $107.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,258.93 / $6,309.57 / $12,022.64
| Facility | | $1,258.93 | $6,309.57 | $12,022.64 |