- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,816.47 / $8,788.45 / $20,759.20
| Facility | | $4,816.47 | $8,788.45 | $20,759.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,109.51 / $9,197.75 / $16,512.25
| Facility | | $3,109.51 | $9,197.75 | $16,512.25 |
- 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
- $943.24 / $1,245.74 / $2,125.29
| Facility | | $943.24 | $1,245.74 | $2,125.29 |
- Facility/Professional
- Facility
- Modifier
- 80
- Low / Median / High Price
- $247.34 / $260.88 / $349.07
| Facility | 80 | $247.34 | $260.88 | $349.07 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $173.14 / $176.89 / $244.35
| Facility | AS | $173.14 | $176.89 | $244.35 |
- 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 |