- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,120.02 / $9,062.00 / $31,608.40
| Facility | | $1,120.02 | $9,062.00 | $31,608.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,455.11 / $9,243.78 / $15,937.45
| Facility | | $2,455.11 | $9,243.78 | $15,937.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $715.00 / $3,829.28 / $4,920.68
| Facility | | $715.00 | $3,829.28 | $4,920.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $688.75 / $1,066.80 / $1,565.15
| Facility | | $688.75 | $1,066.80 | $1,565.15 |
- Facility/Professional
- Facility
- Modifier
- 80
- Low / Median / High Price
- $175.09 / $219.80 / $313.02
| Facility | 80 | $175.09 | $219.80 | $313.02 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $119.61 / $153.86 / $219.12
| Facility | AS | $119.61 | $153.86 | $219.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,028.00 / $19,627.00 / $25,620.00
| Facility | | $3,028.00 | $19,627.00 | $25,620.00 |