- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,681.90 / $6,886.00 / $39,627.00
| Facility | | $2,681.90 | $6,886.00 | $39,627.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,052.00 / $23,200.00 / $94,529.00
| Facility | | $11,052.00 | $23,200.00 | $94,529.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,086.69 / $2,789.14 / $3,756.04
| Facility | | $2,086.69 | $2,789.14 | $3,756.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,272.63 / $2,995.74 / $4,132.06
| Professional | | $2,272.63 | $2,995.74 | $4,132.06 |
- Facility/Professional
- Professional
- Modifier
- 80
- Low / Median / High Price
- $66.11 / $66.11 / $66.11
| Professional | 80 | $66.11 | $66.11 | $66.11 |
- Facility/Professional
- Professional
- Modifier
- AS
- Low / Median / High Price
- $56.20 / $56.20 / $56.20
| Professional | AS | $56.20 | $56.20 | $56.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,858.00 / $20,006.00 / $30,333.00
| Facility | | $12,858.00 | $20,006.00 | $30,333.00 |