- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,493.81 / $5,041.00 / $11,083.00
| Facility | | $1,493.81 | $5,041.00 | $11,083.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,200.00 / $10,471.00 / $41,059.00
| Facility | | $5,200.00 | $10,471.00 | $41,059.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,306.31 / $21,306.31 / $50,000.00
| Facility | | $21,306.31 | $21,306.31 | $50,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $965.50 / $1,291.32 / $1,737.90
| Facility | | $965.50 | $1,291.32 | $1,737.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,051.53 / $1,386.11 / $1,911.88
| Professional | | $1,051.53 | $1,386.11 | $1,911.88 |
- Facility/Professional
- Professional
- Modifier
- 80
- Low / Median / High Price
- $30.59 / $30.59 / $30.59
| Professional | 80 | $30.59 | $30.59 | $30.59 |
- Facility/Professional
- Professional
- Modifier
- AS
- Low / Median / High Price
- $26.00 / $26.00 / $26.00
| Professional | AS | $26.00 | $26.00 | $26.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,146.00 / $13,967.00 / $28,133.00
| Facility | | $11,146.00 | $13,967.00 | $28,133.00 |