- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,723.45 / $5,503.00 / $10,651.00
| Facility | | $2,723.45 | $5,503.00 | $10,651.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,990.00 / $19,587.00 / $44,198.00
| Facility | | $10,990.00 | $19,587.00 | $44,198.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,614.19 / $3,231.21 / $4,575.39
| Facility | | $2,614.19 | $3,231.21 | $4,575.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,492.65 / $3,554.34 / $4,569.85
| Professional | | $2,492.65 | $3,554.34 | $4,569.85 |
- Facility/Professional
- Professional
- Modifier
- 80
- Low / Median / High Price
- $73.86 / $73.86 / $73.86
| Professional | 80 | $73.86 | $73.86 | $73.86 |
- Facility/Professional
- Professional
- Modifier
- AS
- Low / Median / High Price
- $62.78 / $62.78 / $62.78
| Professional | AS | $62.78 | $62.78 | $62.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,506.00 / $8,565.00 / $14,156.00
| Facility | | $2,506.00 | $8,565.00 | $14,156.00 |