- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,433.43 / $11,550.00 / $18,224.49
| Facility | | $1,433.43 | $11,550.00 | $18,224.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,807.00 / $10,293.98 / $27,368.20
| Facility | | $1,807.00 | $10,293.98 | $27,368.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $890.00 / $1,438.48 / $14,676.49
| Facility | | $890.00 | $1,438.48 | $14,676.49 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $142.94 / $142.94 / $142.94
| Facility | AS | $142.94 | $142.94 | $142.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,380.06 / $1,763.48 / $2,952.36
| Facility | | $1,380.06 | $1,763.48 | $2,952.36 |
- Facility/Professional
- Facility
- Modifier
- 80
- Low / Median / High Price
- $299.58 / $372.20 / $615.38
| Facility | 80 | $299.58 | $372.20 | $615.38 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $209.71 / $260.54 / $430.76
| Facility | AS | $209.71 | $260.54 | $430.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,028.00 / $20,341.00 / $27,446.00
| Facility | | $3,028.00 | $20,341.00 | $27,446.00 |