- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,077.00 / $9,062.00 / $16,843.84
| Facility | | $3,077.00 | $9,062.00 | $16,843.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,068.89 / $7,448.52 / $13,568.66
| Facility | | $3,068.89 | $7,448.52 | $13,568.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $815.00 / $2,831.77 / $3,638.88
| Facility | | $815.00 | $2,831.77 | $3,638.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $722.91 / $990.98 / $1,659.36
| Facility | | $722.91 | $990.98 | $1,659.36 |
- Facility/Professional
- Facility
- Modifier
- 80
- Low / Median / High Price
- $145.60 / $206.76 / $278.75
| Facility | 80 | $145.60 | $206.76 | $278.75 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $101.92 / $144.72 / $195.12
| Facility | AS | $101.92 | $144.72 | $195.12 |
- 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 |