- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,413.33 / $7,828.00 / $16,589.00
| Facility | | $1,413.33 | $7,828.00 | $16,589.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,900.00 / $13,875.00 / $15,752.00
| Facility | | $10,900.00 | $13,875.00 | $15,752.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,171.33 / $1,405.61 / $1,733.58
| Professional | | $1,171.33 | $1,405.61 | $1,733.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,323.53 / $1,734.55 / $2,393.62
| Facility | | $1,323.53 | $1,734.55 | $2,393.62 |
- Facility/Professional
- Facility
- Modifier
- 80
- Low / Median / High Price
- $342.27 / $394.13 / $509.58
| Facility | 80 | $342.27 | $394.13 | $509.58 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $239.59 / $275.89 / $356.71
| Facility | AS | $239.59 | $275.89 | $356.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,284.25 / $1,675.95 / $7,902.00
| Facility | | $1,284.25 | $1,675.95 | $7,902.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,367.00 / $13,296.00 / $26,537.00
| Facility | | $8,367.00 | $13,296.00 | $26,537.00 |