- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,551.00 / $5,503.00 / $10,651.00
| Facility | | $2,551.00 | $5,503.00 | $10,651.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,946.00 / $9,278.00 / $17,183.00
| Facility | | $5,946.00 | $9,278.00 | $17,183.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,538.41 / $1,843.95 / $2,584.53
| Facility | | $1,538.41 | $1,843.95 | $2,584.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,408.04 / $2,007.76 / $2,581.41
| Professional | | $1,408.04 | $2,007.76 | $2,581.41 |
- Facility/Professional
- Professional
- Modifier
- 80
- Low / Median / High Price
- $41.72 / $41.72 / $41.72
| Professional | 80 | $41.72 | $41.72 | $41.72 |
- Facility/Professional
- Professional
- Modifier
- AS
- Low / Median / High Price
- $35.46 / $35.46 / $35.46
| Professional | AS | $35.46 | $35.46 | $35.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,292.00 / $8,535.00 / $12,740.00
| Facility | | $1,292.00 | $8,535.00 | $12,740.00 |