- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $2,884.03 / $2,884.03
| Facility | | $501.19 | $2,884.03 | $2,884.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.03 / $537.03 / $645.65
| Facility | | $537.03 | $537.03 | $645.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.67 / $851.14 / $851.14
| Facility | | $34.67 | $851.14 | $851.14 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $85.11 / $85.11 / $85.11
| Facility | AS | $85.11 | $85.11 | $85.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,548.13 / $3,548.13 / $9,120.11
| Facility | | $3,548.13 | $3,548.13 | $9,120.11 |