- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $642.83 / $3,416.90 / $3,416.90
| Facility | | $642.83 | $3,416.90 | $3,416.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $451.61 / $497.83 / $542.39
| Facility | | $451.61 | $497.83 | $542.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $724.15 / $724.15 / $724.15
| Facility | | $724.15 | $724.15 | $724.15 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $72.42 / $72.42 / $72.42
| Facility | AS | $72.42 | $72.42 | $72.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,429.86 / $2,965.74 / $30,316.68
| Facility | | $2,429.86 | $2,965.74 | $30,316.68 |