- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,182.54 / $5,268.74 / $10,177.70
| Facility | | $1,182.54 | $5,268.74 | $10,177.70 |
- Facility/Professional
- Facility
- Modifier
- 80
- Low / Median / High Price
- $4,421.07 / $4,421.07 / $4,421.07
| Facility | 80 | $4,421.07 | $4,421.07 | $4,421.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,639.91 / $11,851.00 / $26,582.19
| Facility | | $8,639.91 | $11,851.00 | $26,582.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,039.11 / $1,039.11 / $1,039.11
| Facility | | $1,039.11 | $1,039.11 | $1,039.11 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $103.31 / $103.31 / $103.31
| Facility | AS | $103.31 | $103.31 | $103.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,450.54 / $13,269.25 / $30,897.57
| Facility | | $2,450.54 | $13,269.25 | $30,897.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $998.45 / $4,588.12 / $10,203.00
| Facility | | $998.45 | $4,588.12 | $10,203.00 |
- Facility/Professional
- Facility
- Modifier
- 80
- Low / Median / High Price
- $4,421.07 / $4,421.07 / $4,421.07
| Facility | 80 | $4,421.07 | $4,421.07 | $4,421.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,039.11 / $1,039.11 / $1,039.11
| Facility | | $1,039.11 | $1,039.11 | $1,039.11 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $103.31 / $103.31 / $103.31
| Facility | AS | $103.31 | $103.31 | $103.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $877.50 / $896.72 / $896.72
| Facility | | $877.50 | $896.72 | $896.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,468.00 / $7,000.00 / $22,992.86
| Facility | | $2,468.00 | $7,000.00 | $22,992.86 |