- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,873.47 / $4,296.43 / $16,467.00
| Facility | | $1,873.47 | $4,296.43 | $16,467.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $560.00 / $615.00
| Facility | | $100.00 | $560.00 | $615.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $176.72 / $176.72 / $176.72
| Facility | AS | $176.72 | $176.72 | $176.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,592.45 / $1,942.16 / $3,213.48
| Facility | | $1,592.45 | $1,942.16 | $3,213.48 |
- Facility/Professional
- Facility
- Modifier
- 80
- Low / Median / High Price
- $349.00 / $388.43 / $583.09
| Facility | 80 | $349.00 | $388.43 | $583.09 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $244.30 / $267.39 / $408.16
| Facility | AS | $244.30 | $267.39 | $408.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $454.00 / $6,074.00 / $8,818.00
| Facility | | $454.00 | $6,074.00 | $8,818.00 |