- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,285.06 / $5,048.00 / $9,539.00
| Facility | | $2,285.06 | $5,048.00 | $9,539.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,900.00 / $13,875.00 / $15,752.00
| Facility | | $10,900.00 | $13,875.00 | $15,752.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,859.24 / $2,231.09 / $2,751.68
| Professional | | $1,859.24 | $2,231.09 | $2,751.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,231.39 / $2,804.40 / $4,022.91
| Facility | | $2,231.39 | $2,804.40 | $4,022.91 |
- Facility/Professional
- Facility
- Modifier
- 80
- Low / Median / High Price
- $621.70 / $705.28 / $892.81
| Facility | 80 | $621.70 | $705.28 | $892.81 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $435.19 / $493.69 / $624.97
| Facility | AS | $435.19 | $493.69 | $624.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,859.24 / $2,566.56 / $4,829.25
| Facility | | $1,859.24 | $2,566.56 | $4,829.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,547.00 / $3,130.00 / $5,226.00
| Facility | | $1,547.00 | $3,130.00 | $5,226.00 |