- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,266.91 / $8,428.03 / $16,467.00
| Facility | | $4,266.91 | $8,428.03 | $16,467.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,215.37 / $4,266.91 / $7,376.88
| Facility | | $3,215.37 | $4,266.91 | $7,376.88 |
- Facility/Professional
- Facility
- Modifier
- 80
- Low / Median / High Price
- $809.80 / $838.44 / $1,143.80
| Facility | 80 | $809.80 | $838.44 | $1,143.80 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $566.86 / $579.17 / $800.66
| Facility | AS | $566.86 | $579.17 | $800.66 |
- 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 |