- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,529.55 / $6,391.06 / $8,045.46
| Facility | | $5,529.55 | $6,391.06 | $8,045.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $790.64 / $878.69 / $957.35
| Facility | | $790.64 | $878.69 | $957.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $850.72 / $850.72 / $850.72
| Facility | | $850.72 | $850.72 | $850.72 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $84.26 / $84.26 / $84.26
| Facility | AS | $84.26 | $84.26 | $84.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,919.40 / $25,522.62 / $38,535.65
| Facility | | $6,919.40 | $25,522.62 | $38,535.65 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $33,915.76 / $33,915.76 / $42,844.71
| Facility | 50 | $33,915.76 | $33,915.76 | $42,844.71 |