- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $289.41 / $6,903.55 / $6,903.55
| Facility | | $289.41 | $6,903.55 | $6,903.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $186.77 / $193.76 / $244.19
| Facility | | $186.77 | $193.76 | $244.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $208.57 / $208.57 / $208.57
| Facility | | $208.57 | $208.57 | $208.57 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $20.47 / $20.47 / $20.47
| Facility | AS | $20.47 | $20.47 | $20.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,046.82 / $5,046.82 / $5,046.82
| Facility | | $5,046.82 | $5,046.82 | $5,046.82 |