- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,869.00 / $7,617.00 / $18,470.93
| Facility | | $2,869.00 | $7,617.00 | $18,470.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,475.00 / $21,256.00 / $44,941.34
| Facility | | $6,475.00 | $21,256.00 | $44,941.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,586.53 / $2,022.83 / $2,855.75
| Facility | | $1,586.53 | $2,022.83 | $2,855.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,727.90 / $2,356.23 / $3,141.64
| Professional | | $1,727.90 | $2,356.23 | $3,141.64 |
- Facility/Professional
- Professional
- Modifier
- 80
- Low / Median / High Price
- $50.27 / $50.27 / $50.27
| Professional | 80 | $50.27 | $50.27 | $50.27 |
- Facility/Professional
- Professional
- Modifier
- AS
- Low / Median / High Price
- $42.73 / $42.73 / $42.73
| Professional | AS | $42.73 | $42.73 | $42.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,858.00 / $21,127.00 / $30,333.00
| Facility | | $12,858.00 | $21,127.00 | $30,333.00 |