- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,197.00 / $4,682.43 / $13,516.00
| Facility | | $1,197.00 | $4,682.43 | $13,516.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,236.00 / $23,509.00 / $44,198.00
| Facility | | $15,236.00 | $23,509.00 | $44,198.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,008.51 / $13,008.51 / $40,977.51
| Facility | | $13,008.51 | $13,008.51 | $40,977.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,148.78 / $1,493.41 / $2,067.80
| Facility | | $1,148.78 | $1,493.41 | $2,067.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,251.14 / $1,660.60 / $2,559.15
| Professional | | $1,251.14 | $1,660.60 | $2,559.15 |
- Facility/Professional
- Professional
- Modifier
- 80
- Low / Median / High Price
- $36.40 / $36.40 / $36.40
| Professional | 80 | $36.40 | $36.40 | $36.40 |
- Facility/Professional
- Professional
- Modifier
- AS
- Low / Median / High Price
- $30.94 / $30.94 / $30.94
| Professional | AS | $30.94 | $30.94 | $30.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,858.00 / $20,006.00 / $33,017.00
| Facility | | $12,858.00 | $20,006.00 | $33,017.00 |