- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,508.40 / $7,025.34 / $14,548.88
| Facility | | $3,508.40 | $7,025.34 | $14,548.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,216.98 / $9,048.29 / $17,239.93
| Facility | | $3,216.98 | $9,048.29 | $17,239.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,672.98 / $3,672.98 / $4,719.84
| Facility | | $3,672.98 | $3,672.98 | $4,719.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $703.37 / $1,049.00 / $1,582.00
| Facility | | $703.37 | $1,049.00 | $1,582.00 |
- Facility/Professional
- Facility
- Modifier
- 80
- Low / Median / High Price
- $183.40 / $209.80 / $290.64
| Facility | 80 | $183.40 | $209.80 | $290.64 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $128.38 / $146.86 / $203.45
| Facility | AS | $128.38 | $146.86 | $203.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,912.00 / $17,114.00 / $23,485.00
| Facility | | $2,912.00 | $17,114.00 | $23,485.00 |