- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,747.00 / $7,920.26 / $20,400.00
| Facility | | $2,747.00 | $7,920.26 | $20,400.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $842.00 / $842.00 / $842.00
| Facility | | $842.00 | $842.00 | $842.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,433.15 / $4,042.03 / $4,824.45
| Professional | | $3,433.15 | $4,042.03 | $4,824.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,602.91 / $3,452.76 / $4,588.30
| Facility | | $2,602.91 | $3,452.76 | $4,588.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,639.07 / $3,584.16 / $3,772.77
| Facility | | $2,639.07 | $3,584.16 | $3,772.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,602.91 / $3,561.90 / $4,804.50
| Facility | | $2,602.91 | $3,561.90 | $4,804.50 |
- Facility/Professional
- Facility
- Modifier
- 80
- Low / Median / High Price
- $713.06 / $713.06 / $713.06
| Facility | 80 | $713.06 | $713.06 | $713.06 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $606.10 / $606.10 / $606.10
| Facility | AS | $606.10 | $606.10 | $606.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,688.92 / $20,285.91 / $26,041.52
| Facility | | $9,688.92 | $20,285.91 | $26,041.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,433.30 / $15,055.00 / $24,231.00
| Facility | | $1,433.30 | $15,055.00 | $24,231.00 |