- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,757.63 / $5,048.00 / $9,539.00
| Facility | | $2,757.63 | $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
- $2,237.36 / $2,684.83 / $3,311.29
| Professional | | $2,237.36 | $2,684.83 | $3,311.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,652.23 / $3,259.02 / $4,717.29
| Facility | | $2,652.23 | $3,259.02 | $4,717.29 |
- Facility/Professional
- Facility
- Modifier
- 80
- Low / Median / High Price
- $746.97 / $849.10 / $971.64
| Facility | 80 | $746.97 | $849.10 | $971.64 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $522.88 / $594.37 / $680.15
| Facility | AS | $522.88 | $594.37 | $680.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,013.62 / $3,034.49 / $5,834.73
| Facility | | $2,013.62 | $3,034.49 | $5,834.73 |
- 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 |