- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $977.24 / $5,370.32 / $7,413.10
| Facility | | $977.24 | $5,370.32 | $7,413.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,174.90 / $2,754.23 / $6,025.60
| Facility | | $1,174.90 | $2,754.23 | $6,025.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.83 / $1,000.00 / $2,187.76
| Facility | | $812.83 | $1,000.00 | $2,187.76 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $81.28 / $81.28 / $81.28
| Facility | AS | $81.28 | $81.28 | $81.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $501.19 / $741.31 / $2,630.27
| Professional | | $501.19 | $741.31 | $2,630.27 |
- Facility/Professional
- Professional
- Modifier
- 80
- Low / Median / High Price
- $37.15 / $37.15 / $37.15
| Professional | 80 | $37.15 | $37.15 | $37.15 |
- Facility/Professional
- Professional
- Modifier
- AS
- Low / Median / High Price
- $18.62 / $18.62 / $18.62
| Professional | AS | $18.62 | $18.62 | $18.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $5,623.41 / $8,511.38
| Facility | | $1,513.56 | $5,623.41 | $8,511.38 |