- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,626.00 / $3,342.00 / $12,747.14
| Facility | | $2,626.00 | $3,342.00 | $12,747.14 |
- 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
- $1,510.31 / $2,033.11 / $2,537.32
| Facility | | $1,510.31 | $2,033.11 | $2,537.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,815.28 / $2,236.42 / $2,875.40
| Professional | | $1,815.28 | $2,236.42 | $2,875.40 |
- Facility/Professional
- Professional
- Modifier
- 80
- Low / Median / High Price
- $46.47 / $46.47 / $46.47
| Professional | 80 | $46.47 | $46.47 | $46.47 |
- Facility/Professional
- Professional
- Modifier
- AS
- Low / Median / High Price
- $39.50 / $39.50 / $39.50
| Professional | AS | $39.50 | $39.50 | $39.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,418.00 / $13,938.00 / $28,097.00
| Facility | | $8,418.00 | $13,938.00 | $28,097.00 |