- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $922.31 / $4,230.00 / $9,870.00
| Facility | | $922.31 | $4,230.00 | $9,870.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,113.91 / $34,516.71 / $64,336.12
| Facility | | $7,113.91 | $34,516.71 | $64,336.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,998.77 / $21,998.77 / $28,268.81
| Facility | | $21,998.77 | $21,998.77 | $28,268.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $781.93 / $1,110.09 / $1,811.83
| Facility | | $781.93 | $1,110.09 | $1,811.83 |
- Facility/Professional
- Facility
- Modifier
- 80
- Low / Median / High Price
- $211.20 / $236.62 / $362.37
| Facility | 80 | $211.20 | $236.62 | $362.37 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $143.18 / $165.63 / $253.66
| Facility | AS | $143.18 | $165.63 | $253.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,960.00 / $23,322.00 / $35,711.00
| Facility | | $3,960.00 | $23,322.00 | $35,711.00 |