- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,109.68 / $1,109.68 / $21,296.10
| Facility | | $1,109.68 | $1,109.68 | $21,296.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,384.27 / $2,081.80 / $38,105.80
| Professional | | $1,384.27 | $2,081.80 | $38,105.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,098.00 / $16,131.00 / $45,000.00
| Facility | | $12,098.00 | $16,131.00 | $45,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $884.42 / $7,780.42 / $26,466.06
| Professional | | $884.42 | $7,780.42 | $26,466.06 |
- Facility/Professional
- Professional
- Modifier
- 80
- Low / Median / High Price
- $141.50 / $1,244.85 / $4,234.57
| Professional | 80 | $141.50 | $1,244.85 | $4,234.57 |
- Facility/Professional
- Professional
- Modifier
- AS
- Low / Median / High Price
- $123.81 / $1,089.25 / $3,705.24
| Professional | AS | $123.81 | $1,089.25 | $3,705.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13,725.93 / $13,725.93 / $15,470.60
| Professional | | $13,725.93 | $13,725.93 | $15,470.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10,925.30 / $18,637.27 / $43,031.46
| Professional | | $10,925.30 | $18,637.27 | $43,031.46 |