- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,834.02 / $9,602.50 / $22,381.74
| Facility | | $1,834.02 | $9,602.50 | $22,381.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,900.00 / $13,875.00 / $15,752.00
| Facility | | $10,900.00 | $13,875.00 | $15,752.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $861.77 / $1,034.11 / $1,275.42
| Professional | | $861.77 | $1,034.11 | $1,275.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $817.42 / $1,200.68 / $1,650.01
| Facility | | $817.42 | $1,200.68 | $1,650.01 |
- Facility/Professional
- Facility
- Modifier
- 80
- Low / Median / High Price
- $260.06 / $308.82 / $359.13
| Facility | 80 | $260.06 | $308.82 | $359.13 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $182.04 / $216.17 / $251.39
| Facility | AS | $182.04 | $216.17 | $251.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,002.49 / $1,261.71 / $7,902.00
| Facility | | $1,002.49 | $1,261.71 | $7,902.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,367.00 / $13,296.00 / $26,537.00
| Facility | | $8,367.00 | $13,296.00 | $26,537.00 |