- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,283.89 / $2,561.23 / $16,467.00
| Facility | | $1,283.89 | $2,561.23 | $16,467.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,608.58 / $9,413.49 / $16,208.45
| Facility | | $3,608.58 | $9,413.49 | $16,208.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $986.16 / $1,412.28 / $2,222.44
| Facility | | $986.16 | $1,412.28 | $2,222.44 |
- Facility/Professional
- Facility
- Modifier
- 80
- Low / Median / High Price
- $224.40 / $309.20 / $347.60
| Facility | 80 | $224.40 | $309.20 | $347.60 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $147.76 / $212.66 / $243.32
| Facility | AS | $147.76 | $212.66 | $243.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,028.00 / $19,627.00 / $25,620.00
| Facility | | $3,028.00 | $19,627.00 | $25,620.00 |