- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $954.99 / $3,715.35 / $10,232.93
| Facility | | $954.99 | $3,715.35 | $10,232.93 |
- Facility/Professional
- Facility
- Modifier
- 80
- Low / Median / High Price
- $4,466.84 / $4,466.84 / $4,466.84
| Facility | 80 | $4,466.84 | $4,466.84 | $4,466.84 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $19,952.62 / $19,952.62 / $19,952.62
| Facility | AS | $19,952.62 | $19,952.62 | $19,952.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,981.07 / $11,481.54 / $22,908.68
| Facility | | $3,981.07 | $11,481.54 | $22,908.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $977.24 / $3,162.28 / $11,481.54
| Facility | | $977.24 | $3,162.28 | $11,481.54 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $154.88 / $154.88 / $154.88
| Facility | AS | $154.88 | $154.88 | $154.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,019.95 / $8,709.64 / $19,054.61
| Facility | | $3,019.95 | $8,709.64 | $19,054.61 |