- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,288.25 / $7,244.36 / $19,498.45
| Facility | | $1,288.25 | $7,244.36 | $19,498.45 |
- Facility/Professional
- Facility
- Modifier
- 80
- Low / Median / High Price
- $2,630.27 / $2,630.27 / $2,630.27
| Facility | 80 | $2,630.27 | $2,630.27 | $2,630.27 |
- 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
- $1,380.38 / $4,073.80 / $23,988.33
| Facility | | $1,380.38 | $4,073.80 | $23,988.33 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $138.04 / $138.04 / $138.04
| Facility | AS | $138.04 | $138.04 | $138.04 |
- 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 |