- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $586.73 / $8,960.00 / $16,467.00
| Facility | | $586.73 | $8,960.00 | $16,467.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,068.89 / $7,593.41 / $13,640.30
| Facility | | $3,068.89 | $7,593.41 | $13,640.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,831.77 / $2,831.77 / $3,638.88
| Facility | | $2,831.77 | $2,831.77 | $3,638.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $500.00 / $671.65 / $1,115.48
| Facility | | $500.00 | $671.65 | $1,115.48 |
- Facility/Professional
- Facility
- Modifier
- 80
- Low / Median / High Price
- $127.77 / $133.40 / $205.80
| Facility | 80 | $127.77 | $133.40 | $205.80 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $85.58 / $93.38 / $144.06
| Facility | AS | $85.58 | $93.38 | $144.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,155.00 / $12,798.00 / $19,665.00
| Facility | | $2,155.00 | $12,798.00 | $19,665.00 |