- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,361.60 / $10,501.99 / $14,588.84
| Facility | | $4,361.60 | $10,501.99 | $14,588.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $625.54 / $694.66 / $756.84
| Facility | | $625.54 | $694.66 | $756.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $674.04 / $674.04 / $674.04
| Facility | | $674.04 | $674.04 | $674.04 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $67.11 / $67.11 / $67.11
| Facility | AS | $67.11 | $67.11 | $67.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,050.04 / $3,469.70 / $21,409.59
| Facility | | $1,050.04 | $3,469.70 | $21,409.59 |