- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,965.57 / $14,715.70 / $14,715.70
| Facility | | $1,965.57 | $14,715.70 | $14,715.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,522.19 / $1,522.19 / $1,522.19
| Facility | | $1,522.19 | $1,522.19 | $1,522.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,454.27 / $1,454.27 / $1,454.27
| Facility | | $1,454.27 | $1,454.27 | $1,454.27 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $144.51 / $144.51 / $144.51
| Facility | AS | $144.51 | $144.51 | $144.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,100.26 / $5,100.26 / $13,311.94
| Facility | | $5,100.26 | $5,100.26 | $13,311.94 |