- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $558.51 / $1,981.11 / $16,467.00
| Facility | | $558.51 | $1,981.11 | $16,467.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,891.80 / $6,914.81 / $12,325.76
| Facility | | $2,891.80 | $6,914.81 | $12,325.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $817.53 / $890.00 / $7,936.84
| Facility | | $817.53 | $890.00 | $7,936.84 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $81.75 / $81.75 / $81.75
| Facility | AS | $81.75 | $81.75 | $81.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $558.51 / $869.83 / $1,344.28
| Facility | | $558.51 | $869.83 | $1,344.28 |
- Facility/Professional
- Facility
- Modifier
- 80
- Low / Median / High Price
- $139.63 / $198.67 / $268.87
| Facility | 80 | $139.63 | $198.67 | $268.87 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $97.74 / $139.07 / $188.21
| Facility | AS | $97.74 | $139.07 | $188.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,028.00 / $17,146.00 / $24,161.00
| Facility | | $3,028.00 | $17,146.00 | $24,161.00 |