- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,916.82 / $9,923.00 / $21,886.00
| Facility | | $2,916.82 | $9,923.00 | $21,886.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,740.35 / $9,528.23 / $16,900.34
| Facility | | $3,740.35 | $9,528.23 | $16,900.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,711.96 / $3,711.96 / $4,769.93
| Facility | | $3,711.96 | $3,711.96 | $4,769.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,025.75 / $1,360.00 / $2,399.05
| Facility | | $1,025.75 | $1,360.00 | $2,399.05 |
- Facility/Professional
- Facility
- Modifier
- 80
- Low / Median / High Price
- $223.80 / $272.00 / $395.85
| Facility | 80 | $223.80 | $272.00 | $395.85 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $156.66 / $190.40 / $277.10
| Facility | AS | $156.66 | $190.40 | $277.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,912.00 / $16,959.00 / $23,485.00
| Facility | | $2,912.00 | $16,959.00 | $23,485.00 |