- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,150.00 / $4,930.00 / $16,400.00
| Facility | | $1,150.00 | $4,930.00 | $16,400.00 |
- Facility/Professional
- Facility
- Modifier
- 80
- Low / Median / High Price
- $2,613.60 / $2,613.60 / $2,613.60
| Facility | 80 | $2,613.60 | $2,613.60 | $2,613.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,723.84 / $13,547.08 / $21,288.26
| Facility | | $8,723.84 | $13,547.08 | $21,288.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,321.00 / $2,321.00 / $2,321.00
| Facility | | $2,321.00 | $2,321.00 | $2,321.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $832.54 / $1,627.85 / $13,541.98
| Facility | | $832.54 | $1,627.85 | $13,541.98 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $2,632.21 / $2,632.21 / $2,632.21
| Facility | AS | $2,632.21 | $2,632.21 | $2,632.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,851.00 / $6,980.00 / $13,541.98
| Facility | | $1,851.00 | $6,980.00 | $13,541.98 |