- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $707.95 / $707.95 / $4,570.88
| Facility | | $707.95 | $707.95 | $4,570.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,265.80 / $7,585.78 / $16,218.10
| Facility | | $4,265.80 | $7,585.78 | $16,218.10 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $7,585.78 / $13,803.84 / $34,673.69
| Facility | 50 | $7,585.78 | $13,803.84 | $34,673.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $2,570.40 / $6,025.60
| Facility | | $1,819.70 | $2,570.40 | $6,025.60 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $120.23 / $120.23 / $120.23
| Facility | AS | $120.23 | $120.23 | $120.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,949.84 / $2,454.71 / $4,786.30
| Facility | | $1,949.84 | $2,454.71 | $4,786.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $724.44 / $1,318.26 / $6,760.83
| Facility | | $724.44 | $1,318.26 | $6,760.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $5,248.07 / $8,912.51
| Facility | | $1,584.89 | $5,248.07 | $8,912.51 |