- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,867.26 / $9,838.68 / $21,564.60
| Facility | | $6,867.26 | $9,838.68 | $21,564.60 |
- Facility/Professional
- Facility
- Modifier
- 80
- Low / Median / High Price
- $195.25 / $195.25 / $195.25
| Facility | 80 | $195.25 | $195.25 | $195.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,298.76 / $1,594.36 / $2,010.53
| Professional | | $1,298.76 | $1,594.36 | $2,010.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,340.62 / $1,734.93 / $2,453.91
| Professional | | $1,340.62 | $1,734.93 | $2,453.91 |
- Facility/Professional
- Professional
- Modifier
- AS
- Low / Median / High Price
- $187.68 / $242.89 / $343.54
| Professional | AS | $187.68 | $242.89 | $343.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,301.96 / $1,970.54 / $2,750.42
| Professional | | $1,301.96 | $1,970.54 | $2,750.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,602.63 / $1,854.24 / $2,844.51
| Professional | | $1,602.63 | $1,854.24 | $2,844.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,777.13 / $14,528.76 / $28,302.00
| Facility | | $7,777.13 | $14,528.76 | $28,302.00 |
- Facility/Professional
- Facility
- Modifier
- 80
- Low / Median / High Price
- $195.25 / $195.25 / $195.25
| Facility | 80 | $195.25 | $195.25 | $195.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,409.17 / $1,705.32 / $2,046.65
| Professional | | $1,409.17 | $1,705.32 | $2,046.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,306.08 / $1,867.50 / $2,844.51
| Professional | | $1,306.08 | $1,867.50 | $2,844.51 |