- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,083.23 / $7,299.73 / $25,388.30
| Facility | | $3,083.23 | $7,299.73 | $25,388.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,308.38 / $3,372.00 / $5,303.00
| Facility | | $2,308.38 | $3,372.00 | $5,303.00 |
- Facility/Professional
- Facility
- Modifier
- 80
- Low / Median / High Price
- $598.55 / $674.40 / $933.25
| Facility | 80 | $598.55 | $674.40 | $933.25 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $416.42 / $472.08 / $653.28
| Facility | AS | $416.42 | $472.08 | $653.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $659.00 / $6,107.00 / $8,818.00
| Facility | | $659.00 | $6,107.00 | $8,818.00 |