- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,744.73 / $11,550.00 / $40,425.33
| Facility | | $1,744.73 | $11,550.00 | $40,425.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,401.93 / $21,277.44 / $33,889.28
| Facility | | $9,401.93 | $21,277.44 | $33,889.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $580.00 / $890.00 / $1,753.40
| Facility | | $580.00 | $890.00 | $1,753.40 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $174.63 / $174.63 / $174.63
| Facility | AS | $174.63 | $174.63 | $174.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,589.35 / $1,884.00 / $3,346.18
| Facility | | $1,589.35 | $1,884.00 | $3,346.18 |
- Facility/Professional
- Facility
- Modifier
- 80
- Low / Median / High Price
- $345.53 / $376.80 / $619.91
| Facility | 80 | $345.53 | $376.80 | $619.91 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $241.87 / $263.76 / $433.94
| Facility | AS | $241.87 | $263.76 | $433.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,028.00 / $19,526.00 / $24,161.00
| Facility | | $3,028.00 | $19,526.00 | $24,161.00 |