- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,342.76 / $10,555.00 / $41,726.00
| Facility | | $2,342.76 | $10,555.00 | $41,726.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,475.00 / $36,908.37 / $64,800.00
| Facility | | $6,475.00 | $36,908.37 | $64,800.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,510.65 / $2,007.34 / $2,719.17
| Facility | | $1,510.65 | $2,007.34 | $2,719.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,645.26 / $2,243.54 / $2,991.38
| Professional | | $1,645.26 | $2,243.54 | $2,991.38 |
- Facility/Professional
- Professional
- Modifier
- 80
- Low / Median / High Price
- $47.86 / $47.86 / $47.86
| Professional | 80 | $47.86 | $47.86 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- AS
- Low / Median / High Price
- $40.68 / $40.68 / $40.68
| Professional | AS | $40.68 | $40.68 | $40.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,858.00 / $20,275.00 / $30,333.00
| Facility | | $12,858.00 | $20,275.00 | $30,333.00 |