- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,802.75 / $9,062.00 / $18,276.00
| Facility | | $1,802.75 | $9,062.00 | $18,276.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,114.82 / $27,416.96 / $43,667.88
| Facility | | $12,114.82 | $27,416.96 | $43,667.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $890.00 / $890.00 / $1,815.20
| Facility | | $890.00 | $890.00 | $1,815.20 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $180.56 / $180.56 / $180.56
| Facility | AS | $180.56 | $180.56 | $180.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,712.78 / $2,034.00 / $3,507.08
| Facility | | $1,712.78 | $2,034.00 | $3,507.08 |
- Facility/Professional
- Facility
- Modifier
- 80
- Low / Median / High Price
- $366.28 / $406.80 / $654.92
| Facility | 80 | $366.28 | $406.80 | $654.92 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $250.28 / $284.76 / $458.45
| Facility | AS | $250.28 | $284.76 | $458.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,340.00 / $21,721.00 / $33,364.00
| Facility | | $3,340.00 | $21,721.00 | $33,364.00 |