- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $467.74 / $1,621.81 / $4,073.80
| Facility | | $467.74 | $1,621.81 | $4,073.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $109.65 / $151.36 / $1,621.81
| Facility | | $109.65 | $151.36 | $1,621.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30.20 / $30.20 / $30.20
| Facility | | $30.20 | $30.20 | $30.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $54.95 / $426.58 / $426.58
| Facility | | $54.95 | $426.58 | $426.58 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $42.66 / $42.66 / $42.66
| Facility | AS | $42.66 | $42.66 | $42.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $295.12 / $812.83 / $2,511.89
| Facility | | $295.12 | $812.83 | $2,511.89 |