- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,356.18 / $9,062.00 / $21,365.44
| Facility | | $1,356.18 | $9,062.00 | $21,365.44 |
- 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
- $890.00 / $890.00 / $1,346.11
| Facility | | $890.00 | $890.00 | $1,346.11 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $133.62 / $133.62 / $133.62
| Facility | AS | $133.62 | $133.62 | $133.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,321.31 / $1,578.25 / $2,614.86
| Facility | | $1,321.31 | $1,578.25 | $2,614.86 |
- Facility/Professional
- Facility
- Modifier
- 80
- Low / Median / High Price
- $275.60 / $321.39 / $501.17
| Facility | 80 | $275.60 | $321.39 | $501.17 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $189.58 / $224.98 / $350.82
| Facility | AS | $189.58 | $224.98 | $350.82 |
- 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 |