- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $984.00 / $3,143.36 / $8,573.02
| Facility | | $984.00 | $3,143.36 | $8,573.02 |
- Facility/Professional
- Facility
- Modifier
- 80
- Low / Median / High Price
- $4,421.07 / $4,421.07 / $4,421.07
| Facility | 80 | $4,421.07 | $4,421.07 | $4,421.07 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $20,117.36 / $20,117.36 / $20,117.36
| Facility | AS | $20,117.36 | $20,117.36 | $20,117.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,749.00 / $9,644.00 / $18,544.00
| Facility | | $4,749.00 | $9,644.00 | $18,544.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,003.79 / $3,662.98 / $5,509.46
| Facility | | $2,003.79 | $3,662.98 | $5,509.46 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $103.31 / $103.31 / $103.31
| Facility | AS | $103.31 | $103.31 | $103.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,964.00 / $9,094.60 / $17,327.00
| Facility | | $3,964.00 | $9,094.60 | $17,327.00 |