- 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
- $2,347.71 / $6,547.00 / $13,131.00
| Facility | | $2,347.71 | $6,547.00 | $13,131.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,909.13 / $2,577.33 / $3,784.65
| Facility | | $1,909.13 | $2,577.33 | $3,784.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,061.86 / $2,940.06 / $3,780.08
| Professional | | $2,061.86 | $2,940.06 | $3,780.08 |
- Facility/Professional
- Professional
- Modifier
- 80
- Low / Median / High Price
- $61.09 / $61.09 / $61.09
| Professional | 80 | $61.09 | $61.09 | $61.09 |
- Facility/Professional
- Professional
- Modifier
- AS
- Low / Median / High Price
- $51.93 / $51.93 / $51.93
| Professional | AS | $51.93 | $51.93 | $51.93 |
- 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 |