- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,548.82 / $8,128.31 / $21,877.62
| Facility | | $1,548.82 | $8,128.31 | $21,877.62 |
- Facility/Professional
- Facility
- Modifier
- 80
- Low / Median / High Price
- $1,479.11 / $1,479.11 / $1,479.11
| Facility | 80 | $1,479.11 | $1,479.11 | $1,479.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,011.87 / $13,489.63 / $28,840.32
| Facility | | $5,011.87 | $13,489.63 | $28,840.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,348.96 / $5,011.87 / $22,387.21
| Facility | | $1,348.96 | $5,011.87 | $22,387.21 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $165.96 / $165.96 / $165.96
| Facility | AS | $165.96 | $165.96 | $165.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,019.95 / $9,120.11 / $20,417.38
| Facility | | $3,019.95 | $9,120.11 | $20,417.38 |