- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,603.66 / $9,062.00 / $16,467.00
| Facility | | $6,603.66 | $9,062.00 | $16,467.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,051.00 / $6,401.87 / $10,798.79
| Facility | | $4,051.00 | $6,401.87 | $10,798.79 |
- Facility/Professional
- Facility
- Modifier
- 80
- Low / Median / High Price
- $810.20 / $1,235.81 / $1,759.00
| Facility | 80 | $810.20 | $1,235.81 | $1,759.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $567.14 / $760.53 / $1,231.30
| Facility | AS | $567.14 | $760.53 | $1,231.30 |
- 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 |