- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,001.65 / $9,062.00 / $17,073.65
| Facility | | $1,001.65 | $9,062.00 | $17,073.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,066.59 / $9,627.46 / $18,018.52
| Facility | | $3,066.59 | $9,627.46 | $18,018.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $580.00 / $890.00 / $7,534.67
| Facility | | $580.00 | $890.00 | $7,534.67 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $98.72 / $98.72 / $98.72
| Facility | AS | $98.72 | $98.72 | $98.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $939.60 / $1,212.00 / $1,885.09
| Facility | | $939.60 | $1,212.00 | $1,885.09 |
- Facility/Professional
- Facility
- Modifier
- 80
- Low / Median / High Price
- $202.92 / $252.40 / $353.40
| Facility | 80 | $202.92 | $252.40 | $353.40 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $142.04 / $176.68 / $247.38
| Facility | AS | $142.04 | $176.68 | $247.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,028.00 / $19,526.00 / $24,161.00
| Facility | | $3,028.00 | $19,526.00 | $24,161.00 |