- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,454.85 / $9,062.00 / $18,276.00
| Facility | | $1,454.85 | $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 / $1,463.39
| Facility | | $890.00 | $890.00 | $1,463.39 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $908.75 / $908.75 / $908.75
| Facility | 62 | $908.75 | $908.75 | $908.75 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $145.40 / $145.40 / $145.40
| Facility | AS | $145.40 | $145.40 | $145.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,365.20 / $1,632.00 / $2,804.75
| Facility | | $1,365.20 | $1,632.00 | $2,804.75 |
- Facility/Professional
- Facility
- Modifier
- 80
- Low / Median / High Price
- $294.20 / $326.39 / $525.44
| Facility | 80 | $294.20 | $326.39 | $525.44 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $205.94 / $228.48 / $367.81
| Facility | AS | $205.94 | $228.48 | $367.81 |
- 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 |