- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,285.53 / $1,285.53 / $21,408.70
| Facility | | $1,285.53 | $1,285.53 | $21,408.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,619.91 / $2,436.17 / $37,671.40
| Professional | | $1,619.91 | $2,436.17 | $37,671.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,098.00 / $15,806.00 / $19,757.00
| Facility | | $12,098.00 | $15,806.00 | $19,757.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,023.61 / $7,913.63 / $26,173.51
| Professional | | $1,023.61 | $7,913.63 | $26,173.51 |
- Facility/Professional
- Professional
- Modifier
- 80
- Low / Median / High Price
- $163.77 / $1,266.18 / $4,187.76
| Professional | 80 | $163.77 | $1,266.18 | $4,187.76 |
- Facility/Professional
- Professional
- Modifier
- AS
- Low / Median / High Price
- $143.30 / $1,107.90 / $3,664.29
| Professional | AS | $143.30 | $1,107.90 | $3,664.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14,016.70 / $14,016.70 / $15,325.02
| Professional | | $14,016.70 | $14,016.70 | $15,325.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10,993.65 / $18,699.56 / $40,000.80
| Professional | | $10,993.65 | $18,699.56 | $40,000.80 |