- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,466.97 / $2,918.27 / $16,467.00
| Facility | | $1,466.97 | $2,918.27 | $16,467.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,118.35 / $1,687.02 / $2,537.27
| Facility | | $1,118.35 | $1,687.02 | $2,537.27 |
- Facility/Professional
- Facility
- Modifier
- 80
- Low / Median / High Price
- $284.11 / $351.40 / $433.60
| Facility | 80 | $284.11 | $351.40 | $433.60 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $186.76 / $245.98 / $303.52
| Facility | AS | $186.76 | $245.98 | $303.52 |
- 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 |