- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,803.95 / $7,478.07 / $16,467.00
| Facility | | $3,803.95 | $7,478.07 | $16,467.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,721.21 / $3,803.95 / $6,543.78
| Facility | | $2,721.21 | $3,803.95 | $6,543.78 |
- Facility/Professional
- Facility
- Modifier
- 80
- Low / Median / High Price
- $644.40 / $738.65 / $1,014.88
| Facility | 80 | $644.40 | $738.65 | $1,014.88 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $440.02 / $506.54 / $710.42
| Facility | AS | $440.02 | $506.54 | $710.42 |
- 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 |