- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $907.86 / $11,025.00 / $21,886.00
| Facility | | $907.86 | $11,025.00 | $21,886.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,488.59 / $10,702.85 / $18,562.29
| Facility | | $3,488.59 | $10,702.85 | $18,562.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $728.16 / $998.65 / $1,746.15
| Facility | | $728.16 | $998.65 | $1,746.15 |
- Facility/Professional
- Facility
- Modifier
- 80
- Low / Median / High Price
- $186.40 / $200.15 / $357.05
| Facility | 80 | $186.40 | $200.15 | $357.05 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $130.47 / $137.85 / $249.94
| Facility | AS | $130.47 | $137.85 | $249.94 |
- 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 |