- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,715.25 / $17,039.38 / $46,875.17
| Facility | | $3,715.25 | $17,039.38 | $46,875.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,296.03 / $8,741.20 / $15,485.03
| Facility | | $4,296.03 | $8,741.20 | $15,485.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,229.55 / $6,229.55 / $8,005.08
| Facility | | $6,229.55 | $6,229.55 | $8,005.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $916.34 / $1,253.00 / $2,110.80
| Facility | | $916.34 | $1,253.00 | $2,110.80 |
- Facility/Professional
- Facility
- Modifier
- 80
- Low / Median / High Price
- $244.75 / $254.21 / $353.67
| Facility | 80 | $244.75 | $254.21 | $353.67 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $171.33 / $175.42 / $247.57
| Facility | AS | $171.33 | $175.42 | $247.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,028.00 / $19,627.00 / $25,620.00
| Facility | | $3,028.00 | $19,627.00 | $25,620.00 |