- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $758.58 / $3,548.13 / $11,481.54
| Facility | | $758.58 | $3,548.13 | $11,481.54 |
- Facility/Professional
- Facility
- Modifier
- 80
- Low / Median / High Price
- $3,467.37 / $3,467.37 / $3,467.37
| Facility | 80 | $3,467.37 | $3,467.37 | $3,467.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,511.89 / $6,760.83 / $20,417.38
| Facility | | $2,511.89 | $6,760.83 | $20,417.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $1,949.84 / $5,495.41
| Facility | | $1,096.48 | $1,949.84 | $5,495.41 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $109.65 / $109.65 / $109.65
| Facility | AS | $109.65 | $109.65 | $109.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $5,888.44 / $14,125.38
| Facility | | $1,995.26 | $5,888.44 | $14,125.38 |