- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,060.60 / $7,932.14 / $7,932.14
| Facility | | $1,060.60 | $7,932.14 | $7,932.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.71 / $518.28 / $35,600.00
| Facility | | $0.71 | $518.28 | $35,600.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $120.64 / $120.64 / $120.64
| Facility | AS | $120.64 | $120.64 | $120.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,060.60 / $1,325.76 / $1,989.69
| Facility | | $1,060.60 | $1,325.76 | $1,989.69 |
- Facility/Professional
- Facility
- Modifier
- 80
- Low / Median / High Price
- $229.20 / $267.58 / $397.94
| Facility | 80 | $229.20 | $267.58 | $397.94 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $160.44 / $187.31 / $270.66
| Facility | AS | $160.44 | $187.31 | $270.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $301.00 / $661.00 / $4,877.00
| Facility | | $301.00 | $661.00 | $4,877.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $5,998.32 / $7,360.32
| Facility | | $55.00 | $5,998.32 | $7,360.32 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $243.10 / $528.88 / $528.88
| Facility | AS | $243.10 | $528.88 | $528.88 |