- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $275.42 / $1,348.96 / $2,290.87
| Facility | | $275.42 | $1,348.96 | $2,290.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $288.40 / $288.40 / $354.81
| Facility | | $288.40 | $288.40 | $354.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $467.74 / $467.74 / $2,290.87
| Facility | | $467.74 | $467.74 | $2,290.87 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $46.77 / $46.77 / $46.77
| Facility | AS | $46.77 | $46.77 | $46.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,754.40 / $17,378.01 / $50,118.72
| Facility | | $5,754.40 | $17,378.01 | $50,118.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $2,884.03 / $20,417.38
| Facility | | $2,884.03 | $2,884.03 | $20,417.38 |