- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,106.72 / $9,062.00 / $18,276.00
| Facility | | $1,106.72 | $9,062.00 | $18,276.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,783.09 / $10,824.58 / $17,240.66
| Facility | | $4,783.09 | $10,824.58 | $17,240.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $715.00 / $890.00 / $1,096.91
| Facility | | $715.00 | $890.00 | $1,096.91 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $108.71 / $108.71 / $108.71
| Facility | AS | $108.71 | $108.71 | $108.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,079.06 / $1,374.93 / $2,138.26
| Facility | | $1,079.06 | $1,374.93 | $2,138.26 |
- Facility/Professional
- Facility
- Modifier
- 80
- Low / Median / High Price
- $236.56 / $283.20 / $409.81
| Facility | 80 | $236.56 | $283.20 | $409.81 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $165.59 / $198.24 / $286.87
| Facility | AS | $165.59 | $198.24 | $286.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,912.00 / $16,223.00 / $23,485.00
| Facility | | $2,912.00 | $16,223.00 | $23,485.00 |