- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $253.28 / $501.87 / $16,467.00
| Facility | | $253.28 | $501.87 | $16,467.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $182.38 / $253.28 / $442.52
| Facility | | $182.38 | $253.28 | $442.52 |
- Facility/Professional
- Facility
- Modifier
- 80
- Low / Median / High Price
- $44.00 / $52.40 / $89.21
| Facility | 80 | $44.00 | $52.40 | $89.21 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $30.38 / $35.04 / $62.45
| Facility | AS | $30.38 | $35.04 | $62.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $659.00 / $6,107.00 / $8,818.00
| Facility | | $659.00 | $6,107.00 | $8,818.00 |