- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,952.17 / $8,960.00 / $16,467.00
| Facility | | $2,952.17 | $8,960.00 | $16,467.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $815.00 / $815.00 / $815.00
| Facility | | $815.00 | $815.00 | $815.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,537.84 / $3,395.00 / $6,040.35
| Facility | | $2,537.84 | $3,395.00 | $6,040.35 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $4,116.00 / $5,168.54 / $7,548.14
| Facility | 50 | $4,116.00 | $5,168.54 | $7,548.14 |
- Facility/Professional
- Facility
- Modifier
- 80
- Low / Median / High Price
- $548.79 / $689.14 / $1,006.42
| Facility | 80 | $548.79 | $689.14 | $1,006.42 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $384.16 / $482.40 / $704.49
| Facility | AS | $384.16 | $482.40 | $704.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,311.23 / $15,713.00 / $23,485.00
| Facility | | $2,311.23 | $15,713.00 | $23,485.00 |