- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $977.24 / $6,165.95 / $15,135.61
| Facility | | $977.24 | $6,165.95 | $15,135.61 |
- Facility/Professional
- Facility
- Modifier
- 80
- Low / Median / High Price
- $3,090.30 / $3,090.30 / $3,090.30
| Facility | 80 | $3,090.30 | $3,090.30 | $3,090.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,630.78 / $8,511.38 / $17,378.01
| Facility | | $3,630.78 | $8,511.38 | $17,378.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.83 / $2,137.96 / $15,848.93
| Facility | | $812.83 | $2,137.96 | $15,848.93 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $87.10 / $87.10 / $87.10
| Facility | AS | $87.10 | $87.10 | $87.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,019.95 / $8,709.64 / $18,620.87
| Facility | | $3,019.95 | $8,709.64 | $18,620.87 |