- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,586.07 / $3,581.82 / $16,467.00
| Facility | | $1,586.07 | $3,581.82 | $16,467.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,368.12 / $1,746.09 / $2,958.03
| Facility | | $1,368.12 | $1,746.09 | $2,958.03 |
- Facility/Professional
- Facility
- Modifier
- 80
- Low / Median / High Price
- $349.22 / $349.22 / $486.10
| Facility | 80 | $349.22 | $349.22 | $486.10 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $244.45 / $244.45 / $340.27
| Facility | AS | $244.45 | $244.45 | $340.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $659.00 / $6,107.00 / $8,818.00
| Facility | | $659.00 | $6,107.00 | $8,818.00 |