- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,870.44 / $4,505.38 / $10,806.48
| Facility | | $1,870.44 | $4,505.38 | $10,806.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,162.00 / $17,132.29 / $23,861.81
| Facility | | $11,162.00 | $17,132.29 | $23,861.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,534.05 / $1,840.86 / $2,270.39
| Professional | | $1,534.05 | $1,840.86 | $2,270.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,800.32 / $2,186.04 / $3,269.39
| Facility | | $1,800.32 | $2,186.04 | $3,269.39 |
- Facility/Professional
- Facility
- Modifier
- 80
- Low / Median / High Price
- $427.98 / $498.60 / $658.15
| Facility | 80 | $427.98 | $498.60 | $658.15 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $299.58 / $349.02 / $460.71
| Facility | AS | $299.58 | $349.02 | $460.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,483.57 / $2,142.53 / $9,929.00
| Facility | | $1,483.57 | $2,142.53 | $9,929.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,301.00 / $20,974.00 / $40,876.00
| Facility | | $12,301.00 | $20,974.00 | $40,876.00 |