- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,857.30 / $7,252.00 / $19,533.45
| Facility | | $1,857.30 | $7,252.00 | $19,533.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,772.45 / $8,401.74 / $17,519.04
| Facility | | $2,772.45 | $8,401.74 | $17,519.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $505.00 / $780.00 / $7,818.46
| Facility | | $505.00 | $780.00 | $7,818.46 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $80.08 / $80.08 / $80.08
| Facility | AS | $80.08 | $80.08 | $80.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $687.05 / $811.20 / $1,525.14
| Facility | | $687.05 | $811.20 | $1,525.14 |
- Facility/Professional
- Facility
- Modifier
- 80
- Low / Median / High Price
- $142.40 / $160.62 / $287.29
| Facility | 80 | $142.40 | $160.62 | $287.29 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $99.68 / $112.43 / $201.10
| Facility | AS | $99.68 | $112.43 | $201.10 |
- 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 |