- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,138.92 / $9,062.00 / $18,276.00
| Facility | | $1,138.92 | $9,062.00 | $18,276.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,416.90 / $8,268.12 / $17,077.74
| Facility | | $1,416.90 | $8,268.12 | $17,077.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $715.00 / $890.00 / $1,129.30
| Facility | | $715.00 | $890.00 | $1,129.30 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $111.81 / $111.81 / $111.81
| Facility | AS | $111.81 | $111.81 | $111.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,105.09 / $1,415.61 / $2,193.91
| Facility | | $1,105.09 | $1,415.61 | $2,193.91 |
- Facility/Professional
- Facility
- Modifier
- 80
- Low / Median / High Price
- $245.50 / $293.00 / $420.42
| Facility | 80 | $245.50 | $293.00 | $420.42 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $171.85 / $205.10 / $294.30
| Facility | AS | $171.85 | $205.10 | $294.30 |
- 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 |