- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $743.57 / $743.57 / $743.57
| Facility | | $743.57 | $743.57 | $743.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,088.76 / $4,157.49 / $6,910.70
| Facility | | $2,088.76 | $4,157.49 | $6,910.70 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $3,664.75 / $5,560.23 / $9,749.37
| Facility | 50 | $3,664.75 | $5,560.23 | $9,749.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,794.78 / $2,546.54 / $6,126.04
| Facility | | $1,794.78 | $2,546.54 | $6,126.04 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $87.39 / $87.39 / $87.39
| Facility | AS | $87.39 | $87.39 | $87.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,631.62 / $2,328.14 / $4,823.64
| Facility | | $1,631.62 | $2,328.14 | $4,823.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $806.14 / $1,273.93 / $2,209.66
| Facility | | $806.14 | $1,273.93 | $2,209.66 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $191.46 / $191.46 / $191.46
| Facility | AS | $191.46 | $191.46 | $191.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,028.00 / $11,496.00 / $21,528.00
| Facility | | $5,028.00 | $11,496.00 | $21,528.00 |