- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,288.25 / $1,288.25 / $8,128.31
| Facility | | $1,288.25 | $1,288.25 | $8,128.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,128.31 / $35,481.34 / $83,176.38
| Facility | | $8,128.31 | $35,481.34 | $83,176.38 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $43,651.58 / $81,283.05 / $194,984.46
| Facility | 50 | $43,651.58 | $81,283.05 | $194,984.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,311.31 / $4,677.35 / $11,220.18
| Facility | | $3,311.31 | $4,677.35 | $11,220.18 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $234.42 / $234.42 / $234.42
| Facility | AS | $234.42 | $234.42 | $234.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,630.78 / $4,466.84 / $8,912.51
| Facility | | $3,630.78 | $4,466.84 | $8,912.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,288.25 / $2,238.72 / $7,585.78
| Facility | | $1,288.25 | $2,238.72 | $7,585.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $8,128.31 / $28,183.83
| Facility | | $1,584.89 | $8,128.31 | $28,183.83 |