- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,338.30 / $9,062.00 / $21,787.06
| Facility | | $3,338.30 | $9,062.00 | $21,787.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,205.70 / $9,931.03 / $18,801.00
| Facility | | $4,205.70 | $9,931.03 | $18,801.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $505.00 / $3,639.40 / $4,676.68
| Facility | | $505.00 | $3,639.40 | $4,676.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $694.33 / $940.00 / $1,549.54
| Facility | | $694.33 | $940.00 | $1,549.54 |
- Facility/Professional
- Facility
- Modifier
- 80
- Low / Median / High Price
- $187.70 / $191.47 / $255.27
| Facility | 80 | $187.70 | $191.47 | $255.27 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $131.38 / $133.34 / $178.69
| Facility | AS | $131.38 | $133.34 | $178.69 |
- 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 |