- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,754.23 / $5,623.41 / $9,549.93
| Facility | | $2,754.23 | $5,623.41 | $9,549.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,380.38 / $3,467.37 / $6,918.31
| Facility | | $1,380.38 | $3,467.37 | $6,918.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.96 / $5,011.87 / $9,772.37
| Facility | | $2,137.96 | $5,011.87 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,047.13 / $1,513.56 / $8,709.64
| Professional | | $1,047.13 | $1,513.56 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- 80
- Low / Median / High Price
- $75.86 / $75.86 / $117.49
| Professional | 80 | $75.86 | $75.86 | $117.49 |
- 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 |