- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,512.43 / $4,451.17 / $9,918.00
| Facility | | $1,512.43 | $4,451.17 | $9,918.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,525.00 / $11,065.00 / $12,418.00
| Facility | | $8,525.00 | $11,065.00 | $12,418.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,238.05 / $1,485.66 / $1,832.31
| Professional | | $1,238.05 | $1,485.66 | $1,832.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,458.32 / $1,801.48 / $2,470.77
| Facility | | $1,458.32 | $1,801.48 | $2,470.77 |
- Facility/Professional
- Facility
- Modifier
- 80
- Low / Median / High Price
- $360.30 / $399.11 / $532.08
| Facility | 80 | $360.30 | $399.11 | $532.08 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $252.21 / $279.38 / $372.46
| Facility | AS | $252.21 | $279.38 | $372.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,342.82 / $1,769.13 / $3,217.20
| Facility | | $1,342.82 | $1,769.13 | $3,217.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,547.00 / $3,130.00 / $5,226.00
| Facility | | $1,547.00 | $3,130.00 | $5,226.00 |