- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $736.94 / $8,960.00 / $16,467.00
| Facility | | $736.94 | $8,960.00 | $16,467.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,543.00 / $10,380.37 / $18,872.41
| Facility | | $3,543.00 | $10,380.37 | $18,872.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,639.40 / $3,639.40 / $4,676.68
| Facility | | $3,639.40 | $3,639.40 | $4,676.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $688.27 / $874.69 / $1,553.37
| Facility | | $688.27 | $874.69 | $1,553.37 |
- Facility/Professional
- Facility
- Modifier
- 80
- Low / Median / High Price
- $171.35 / $174.94 / $255.53
| Facility | 80 | $171.35 | $174.94 | $255.53 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $119.42 / $122.46 / $178.87
| Facility | AS | $119.42 | $122.46 | $178.87 |
- 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 |