- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,690.59 / $1,690.59 / $6,201.18
| Facility | | $1,690.59 | $1,690.59 | $6,201.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $722.88 / $793.57 / $864.61
| Facility | | $722.88 | $793.57 | $864.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $793.36 / $793.36 / $793.36
| Facility | | $793.36 | $793.36 | $793.36 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $79.34 / $79.34 / $79.34
| Facility | AS | $79.34 | $79.34 | $79.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,892.78 / $2,892.78 / $6,711.14
| Facility | | $2,892.78 | $2,892.78 | $6,711.14 |