- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,558.59 / $9,620.00 / $40,153.75
| Facility | | $2,558.59 | $9,620.00 | $40,153.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,900.00 / $13,875.00 / $15,752.00
| Facility | | $10,900.00 | $13,875.00 | $15,752.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,408.39 / $1,690.07 / $2,084.42
| Professional | | $1,408.39 | $1,690.07 | $2,084.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,594.29 / $2,062.19 / $2,759.76
| Facility | | $1,594.29 | $2,062.19 | $2,759.76 |
- Facility/Professional
- Facility
- Modifier
- 80
- Low / Median / High Price
- $380.92 / $470.01 / $608.70
| Facility | 80 | $380.92 | $470.01 | $608.70 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $266.64 / $329.01 / $426.09
| Facility | AS | $266.64 | $329.01 | $426.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,465.89 / $1,996.66 / $7,902.00
| Facility | | $1,465.89 | $1,996.66 | $7,902.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,367.00 / $13,296.00 / $26,537.00
| Facility | | $8,367.00 | $13,296.00 | $26,537.00 |