- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $3,964.60 / $9,329.00
| Facility | | $1,000.00 | $3,964.60 | $9,329.00 |
- Facility/Professional
- Facility
- Modifier
- 80
- Low / Median / High Price
- $5,205.97 / $5,205.97 / $5,205.97
| Facility | 80 | $5,205.97 | $5,205.97 | $5,205.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,302.10 / $6,090.00 / $14,996.00
| Facility | | $3,302.10 | $6,090.00 | $14,996.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,185.00 / $2,000.00 / $2,710.28
| Facility | | $1,185.00 | $2,000.00 | $2,710.28 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $76.76 / $76.76 / $76.76
| Facility | AS | $76.76 | $76.76 | $76.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,028.00 / $7,457.00 / $14,139.00
| Facility | | $3,028.00 | $7,457.00 | $14,139.00 |