- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,215.04 / $3,215.04 / $8,659.28
| Facility | | $3,215.04 | $3,215.04 | $8,659.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $475.29 / $537.00 / $585.08
| Facility | | $475.29 | $537.00 | $585.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $509.08 / $509.08 / $509.08
| Facility | | $509.08 | $509.08 | $509.08 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $50.41 / $50.41 / $50.41
| Facility | AS | $50.41 | $50.41 | $50.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,161.96 / $12,097.60 / $30,885.15
| Facility | | $5,161.96 | $12,097.60 | $30,885.15 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $11,451.64 / $11,451.64 / $11,451.64
| Facility | 50 | $11,451.64 | $11,451.64 | $11,451.64 |