- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $932.58 / $5,149.18 / $10,965.60
| Facility | | $932.58 | $5,149.18 | $10,965.60 |
- Facility/Professional
- Facility
- Modifier
- 80
- Low / Median / High Price
- $3,109.00 / $3,109.00 / $3,109.00
| Facility | 80 | $3,109.00 | $3,109.00 | $3,109.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,568.00 / $7,578.00 / $15,328.00
| Facility | | $4,568.00 | $7,578.00 | $15,328.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,012.85 / $3,736.36 / $4,701.65
| Facility | | $3,012.85 | $3,736.36 | $4,701.65 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $57.90 / $57.90 / $57.90
| Facility | AS | $57.90 | $57.90 | $57.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,062.00 / $8,220.00 / $14,242.22
| Facility | | $4,062.00 | $8,220.00 | $14,242.22 |