- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,989.00 / $7,674.00 / $22,030.97
| Facility | | $2,989.00 | $7,674.00 | $22,030.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,330.00 / $37,869.43 / $64,800.00
| Facility | | $15,330.00 | $37,869.43 | $64,800.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,285.57 / $1,627.56 / $2,314.03
| Facility | | $1,285.57 | $1,627.56 | $2,314.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,400.12 / $1,909.26 / $2,545.67
| Professional | | $1,400.12 | $1,909.26 | $2,545.67 |
- Facility/Professional
- Professional
- Modifier
- 22
- Low / Median / High Price
- $2,138.37 / $2,138.37 / $2,138.37
| Professional | 22 | $2,138.37 | $2,138.37 | $2,138.37 |
- Facility/Professional
- Professional
- Modifier
- 80
- Low / Median / High Price
- $40.72 / $40.72 / $40.72
| Professional | 80 | $40.72 | $40.72 | $40.72 |
- Facility/Professional
- Professional
- Modifier
- AS
- Low / Median / High Price
- $34.61 / $34.61 / $34.61
| Professional | AS | $34.61 | $34.61 | $34.61 |
- 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 |