- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,366.81 / $1,366.81 / $4,338.00
| Facility | | $1,366.81 | $1,366.81 | $4,338.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,325.28 / $2,134.52 / $3,416.84
| Facility | | $1,325.28 | $2,134.52 | $3,416.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,471.54 / $3,201.51 / $4,199.47
| Facility | | $2,471.54 | $3,201.51 | $4,199.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,745.45 / $2,279.25 / $2,598.60
| Professional | | $1,745.45 | $2,279.25 | $2,598.60 |
- Facility/Professional
- Professional
- Modifier
- 80
- Low / Median / High Price
- $519.38 / $519.38 / $519.38
| Professional | 80 | $519.38 | $519.38 | $519.38 |
- Facility/Professional
- Professional
- Modifier
- AS
- Low / Median / High Price
- $519.38 / $519.38 / $519.38
| Professional | AS | $519.38 | $519.38 | $519.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,000.00 / $2,000.00 / $2,000.00
| Facility | | $2,000.00 | $2,000.00 | $2,000.00 |