- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,207.58 / $11,018.00 / $14,548.88
| Facility | | $2,207.58 | $11,018.00 | $14,548.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,916.56 / $7,611.04 / $13,640.30
| Facility | | $2,916.56 | $7,611.04 | $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
- $791.41 / $1,094.00 / $1,793.94
| Facility | | $791.41 | $1,094.00 | $1,793.94 |
- Facility/Professional
- Facility
- Modifier
- 80
- Low / Median / High Price
- $206.78 / $225.78 / $308.58
| Facility | 80 | $206.78 | $225.78 | $308.58 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $144.75 / $153.16 / $216.01
| Facility | AS | $144.75 | $153.16 | $216.01 |
- 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 |