- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,215.60 / $13,029.65 / $22,275.75
| Facility | | $5,215.60 | $13,029.65 | $22,275.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,186.96 / $10,755.54 / $18,458.66
| Facility | | $4,186.96 | $10,755.54 | $18,458.66 |
- 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
- $859.51 / $1,167.54 / $1,809.92
| Facility | | $859.51 | $1,167.54 | $1,809.92 |
- Facility/Professional
- Facility
- Modifier
- 80
- Low / Median / High Price
- $217.61 / $233.51 / $400.51
| Facility | 80 | $217.61 | $233.51 | $400.51 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $152.33 / $163.46 / $280.36
| Facility | AS | $152.33 | $163.46 | $280.36 |
- 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 |