- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $773.75 / $8,960.00 / $15,203.95
| Facility | | $773.75 | $8,960.00 | $15,203.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,638.07 / $10,002.37 / $17,689.34
| Facility | | $4,638.07 | $10,002.37 | $17,689.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,971.55 / $3,971.55 / $5,103.52
| Facility | | $3,971.55 | $3,971.55 | $5,103.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $690.42 / $940.09 / $1,496.17
| Facility | | $690.42 | $940.09 | $1,496.17 |
- Facility/Professional
- Facility
- Modifier
- 80
- Low / Median / High Price
- $173.35 / $188.02 / $250.29
| Facility | 80 | $173.35 | $188.02 | $250.29 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $121.35 / $131.61 / $175.20
| Facility | AS | $121.35 | $131.61 | $175.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,442.70 / $15,451.00 / $23,485.00
| Facility | | $5,442.70 | $15,451.00 | $23,485.00 |