- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,340.49 / $6,886.00 / $460,696.10
| Facility | | $1,340.49 | $6,886.00 | $460,696.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,586.00 / $8,579.00 / $17,457.75
| Facility | | $4,586.00 | $8,579.00 | $17,457.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,340.49 / $1,753.58 / $2,278.83
| Facility | | $1,340.49 | $1,753.58 | $2,278.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,459.94 / $1,924.47 / $2,654.44
| Professional | | $1,459.94 | $1,924.47 | $2,654.44 |
- Facility/Professional
- Professional
- Modifier
- 22
- Low / Median / High Price
- $2,229.73 / $2,229.73 / $2,229.73
| Professional | 22 | $2,229.73 | $2,229.73 | $2,229.73 |
- Facility/Professional
- Professional
- Modifier
- 80
- Low / Median / High Price
- $42.47 / $42.47 / $42.47
| Professional | 80 | $42.47 | $42.47 | $42.47 |
- Facility/Professional
- Professional
- Modifier
- AS
- Low / Median / High Price
- $36.10 / $36.10 / $36.10
| Professional | AS | $36.10 | $36.10 | $36.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,251.00 / $11,924.00 / $19,712.00
| Facility | | $9,251.00 | $11,924.00 | $19,712.00 |