- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,328.55 / $1,328.55 / $27,302.70
| Facility | | $1,328.55 | $1,328.55 | $27,302.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,671.50 / $2,513.75 / $51,550.40
| Professional | | $1,671.50 | $2,513.75 | $51,550.40 |
- 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
- $1,058.14 / $9,936.29 / $35,796.44
| Professional | | $1,058.14 | $9,936.29 | $35,796.44 |
- Facility/Professional
- Professional
- Modifier
- 80
- Low / Median / High Price
- $169.30 / $1,589.80 / $5,727.43
| Professional | 80 | $169.30 | $1,589.80 | $5,727.43 |
- Facility/Professional
- Professional
- Modifier
- AS
- Low / Median / High Price
- $148.13 / $1,391.08 / $5,011.50
| Professional | AS | $148.13 | $1,391.08 | $5,011.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17,531.50 / $17,531.50 / $20,926.97
| Professional | | $17,531.50 | $17,531.50 | $20,926.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14,879.11 / $25,010.79 / $47,229.00
| Professional | | $14,879.11 | $25,010.79 | $47,229.00 |