- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,160.96 / $5,412.00 / $10,767.00
| Facility | | $3,160.96 | $5,412.00 | $10,767.00 |
- 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
- $2,571.44 / $3,085.74 / $3,805.75
| Professional | | $2,571.44 | $3,085.74 | $3,805.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,062.98 / $3,735.68 / $5,479.74
| Facility | | $3,062.98 | $3,735.68 | $5,479.74 |
- Facility/Professional
- Facility
- Modifier
- 80
- Low / Median / High Price
- $859.56 / $975.91 / $1,113.25
| Facility | 80 | $859.56 | $975.91 | $1,113.25 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $601.70 / $683.14 / $779.27
| Facility | AS | $601.70 | $683.14 | $779.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,070.00 / $3,456.41 / $6,693.62
| Facility | | $2,070.00 | $3,456.41 | $6,693.62 |
- 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 |