- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,103.88 / $7,799.00 / $16,467.00
| Facility | | $1,103.88 | $7,799.00 | $16,467.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,807.44 / $7,807.44 / $7,807.44
| Facility | | $7,807.44 | $7,807.44 | $7,807.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $843.12 / $1,269.46 / $1,913.25
| Facility | | $843.12 | $1,269.46 | $1,913.25 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $1,637.52 / $2,053.50 / $2,783.07
| Facility | 50 | $1,637.52 | $2,053.50 | $2,783.07 |
- Facility/Professional
- Facility
- Modifier
- 80
- Low / Median / High Price
- $218.34 / $273.80 / $371.08
| Facility | 80 | $218.34 | $273.80 | $371.08 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $149.60 / $191.66 / $259.75
| Facility | AS | $149.60 | $191.66 | $259.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $659.00 / $6,107.00 / $8,818.00
| Facility | | $659.00 | $6,107.00 | $8,818.00 |