- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,095.86 / $3,608.51 / $10,651.00
| Facility | | $2,095.86 | $3,608.51 | $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
- $2,095.86 / $2,515.03 / $3,521.04
| Facility | | $2,095.86 | $2,515.03 | $3,521.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,918.24 / $2,735.27 / $3,516.78
| Professional | | $1,918.24 | $2,735.27 | $3,516.78 |
- Facility/Professional
- Professional
- Modifier
- 80
- Low / Median / High Price
- $56.84 / $56.84 / $56.84
| Professional | 80 | $56.84 | $56.84 | $56.84 |
- Facility/Professional
- Professional
- Modifier
- AS
- Low / Median / High Price
- $48.31 / $48.31 / $48.31
| Professional | AS | $48.31 | $48.31 | $48.31 |
- 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 |