- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $480.91 / $755.71 / $6,106.81
| Facility | | $480.91 | $755.71 | $6,106.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $529.72 / $585.24 / $637.63
| Facility | | $529.72 | $585.24 | $637.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $565.41 / $565.41 / $565.41
| Facility | | $565.41 | $565.41 | $565.41 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $56.11 / $56.11 / $56.11
| Facility | AS | $56.11 | $56.11 | $56.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,523.54 / $1,523.54 / $4,281.50
| Facility | | $1,523.54 | $1,523.54 | $4,281.50 |