- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $707.95 / $707.95 / $2,290.87
| Facility | | $707.95 | $707.95 | $2,290.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $758.58 / $758.58 / $912.01
| Facility | | $758.58 | $758.58 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.67 / $1,230.27 / $1,230.27
| Facility | | $34.67 | $1,230.27 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $123.03 / $123.03 / $123.03
| Facility | AS | $123.03 | $123.03 | $123.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $2,884.03 / $9,120.11
| Facility | | $2,884.03 | $2,884.03 | $9,120.11 |