- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,589.10 / $8,589.10 / $21,958.40
| Facility | | $8,589.10 | $8,589.10 | $21,958.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,250.58 / $1,418.20 / $1,545.14
| Facility | | $1,250.58 | $1,418.20 | $1,545.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,340.32 / $1,340.32 / $1,340.32
| Facility | | $1,340.32 | $1,340.32 | $1,340.32 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $132.54 / $132.54 / $132.54
| Facility | AS | $132.54 | $132.54 | $132.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,248.39 / $27,411.26 / $35,391.49
| Facility | | $10,248.39 | $27,411.26 | $35,391.49 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $37,203.37 / $37,203.37 / $37,203.37
| Facility | 50 | $37,203.37 | $37,203.37 | $37,203.37 |