- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,120.88 / $7,799.00 / $11,867.95
| Facility | | $1,120.88 | $7,799.00 | $11,867.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,881.07 / $6,466.05 / $11,397.34
| Facility | | $2,881.07 | $6,466.05 | $11,397.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $505.00 / $505.00 / $1,985.43
| Facility | | $505.00 | $505.00 | $1,985.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $821.00 / $1,086.00 / $1,579.42
| Facility | | $821.00 | $1,086.00 | $1,579.42 |
- Facility/Professional
- Facility
- Modifier
- 80
- Low / Median / High Price
- $164.20 / $212.20 / $315.88
| Facility | 80 | $164.20 | $212.20 | $315.88 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $114.94 / $148.54 / $201.46
| Facility | AS | $114.94 | $148.54 | $201.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,779.00 / $12,456.00 / $19,591.00
| Facility | | $1,779.00 | $12,456.00 | $19,591.00 |