- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,440.80 / $9,300.29 / $13,901.75
| Facility | | $4,440.80 | $9,300.29 | $13,901.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,279.69 / $9,418.29 / $17,884.22
| Facility | | $3,279.69 | $9,418.29 | $17,884.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $580.00 / $749.93 / $5,740.31
| Facility | | $580.00 | $749.93 | $5,740.31 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $74.34 / $74.34 / $74.34
| Facility | AS | $74.34 | $74.34 | $74.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $739.07 / $943.56 / $1,441.26
| Facility | | $739.07 | $943.56 | $1,441.26 |
- Facility/Professional
- Facility
- Modifier
- 80
- Low / Median / High Price
- $161.60 / $203.40 / $279.63
| Facility | 80 | $161.60 | $203.40 | $279.63 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $113.12 / $142.38 / $195.74
| Facility | AS | $113.12 | $142.38 | $195.74 |
- 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 |