- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,274.70 / $4,937.00 / $12,635.86
| Facility | | $1,274.70 | $4,937.00 | $12,635.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,707.73 / $2,175.26 / $3,528.90
| Facility | | $1,707.73 | $2,175.26 | $3,528.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,996.94 / $2,995.92 / $4,256.85
| Facility | | $1,996.94 | $2,995.92 | $4,256.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,695.80 / $2,333.56 / $2,715.69
| Professional | | $1,695.80 | $2,333.56 | $2,715.69 |
- Facility/Professional
- Professional
- Modifier
- 80
- Low / Median / High Price
- $512.55 / $512.55 / $512.55
| Professional | 80 | $512.55 | $512.55 | $512.55 |
- Facility/Professional
- Professional
- Modifier
- AS
- Low / Median / High Price
- $512.55 / $512.55 / $512.55
| Professional | AS | $512.55 | $512.55 | $512.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,714.00 / $2,714.00 / $2,714.00
| Facility | | $2,714.00 | $2,714.00 | $2,714.00 |