- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,412.05 / $9,062.00 / $18,276.00
| Facility | | $1,412.05 | $9,062.00 | $18,276.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,574.01 / $8,268.12 / $17,077.74
| Facility | | $1,574.01 | $8,268.12 | $17,077.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $815.00 / $890.00 / $1,399.57
| Facility | | $815.00 | $890.00 | $1,399.57 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $138.28 / $138.28 / $138.28
| Facility | AS | $138.28 | $138.28 | $138.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,374.30 / $1,765.07 / $2,730.77
| Facility | | $1,374.30 | $1,765.07 | $2,730.77 |
- Facility/Professional
- Facility
- Modifier
- 80
- Low / Median / High Price
- $307.57 / $375.40 / $523.66
| Facility | 80 | $307.57 | $375.40 | $523.66 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $215.30 / $262.77 / $366.56
| Facility | AS | $215.30 | $262.77 | $366.56 |
- 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 |