- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,152.00 / $8,990.10 / $19,598.41
| Facility | | $4,152.00 | $8,990.10 | $19,598.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,111.52 / $7,695.34 / $13,640.30
| Facility | | $3,111.52 | $7,695.34 | $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
- $874.32 / $1,233.00 / $1,994.11
| Facility | | $874.32 | $1,233.00 | $1,994.11 |
- Facility/Professional
- Facility
- Modifier
- 80
- Low / Median / High Price
- $230.81 / $249.77 / $333.91
| Facility | 80 | $230.81 | $249.77 | $333.91 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $161.57 / $172.62 / $233.74
| Facility | AS | $161.57 | $172.62 | $233.74 |
- 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 |