- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,588.80 / $3,158.34 / $16,467.00
| Facility | | $1,588.80 | $3,158.34 | $16,467.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,214.04 / $1,827.12 / $2,744.74
| Facility | | $1,214.04 | $1,827.12 | $2,744.74 |
- Facility/Professional
- Facility
- Modifier
- 80
- Low / Median / High Price
- $307.67 / $384.20 / $428.63
| Facility | 80 | $307.67 | $384.20 | $428.63 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $207.06 / $268.94 / $300.04
| Facility | AS | $207.06 | $268.94 | $300.04 |
- 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 |