- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,362.48 / $9,584.40 / $16,467.00
| Facility | | $1,362.48 | $9,584.40 | $16,467.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,752.53 / $10,824.58 / $22,240.91
| Facility | | $4,752.53 | $10,824.58 | $22,240.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $890.00 / $890.00 / $1,352.50
| Facility | | $890.00 | $890.00 | $1,352.50 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $134.18 / $134.18 / $134.18
| Facility | AS | $134.18 | $134.18 | $134.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,327.90 / $1,574.36 / $2,630.12
| Facility | | $1,327.90 | $1,574.36 | $2,630.12 |
- Facility/Professional
- Facility
- Modifier
- 80
- Low / Median / High Price
- $288.00 / $321.64 / $555.62
| Facility | 80 | $288.00 | $321.64 | $555.62 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $201.60 / $225.15 / $388.93
| Facility | AS | $201.60 | $225.15 | $388.93 |
- 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 |