- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $478.63 / $676.08 / $1,412.54
| Facility | | $478.63 | $676.08 | $1,412.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $512.86 / $512.86 / $602.56
| Facility | | $512.86 | $512.86 | $602.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.67 / $812.83 / $812.83
| Facility | | $34.67 | $812.83 | $812.83 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $81.28 / $81.28 / $81.28
| Facility | AS | $81.28 | $81.28 | $81.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,951.21 / $2,951.21 / $21,379.62
| Facility | | $2,951.21 | $2,951.21 | $21,379.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,466.84 / $4,466.84 / $20,417.38
| Facility | | $4,466.84 | $4,466.84 | $20,417.38 |