- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $660.69 / $15,135.61 / $15,135.61
| Facility | | $660.69 | $15,135.61 | $15,135.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $724.44 / $724.44 / $870.96
| Facility | | $724.44 | $724.44 | $870.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,148.15 / $1,148.15 / $1,862.09
| Facility | | $1,148.15 | $1,148.15 | $1,862.09 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $114.82 / $114.82 / $114.82
| Facility | AS | $114.82 | $114.82 | $114.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,290.87 / $2,290.87 / $3,162.28
| Facility | | $2,290.87 | $2,290.87 | $3,162.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,466.84 / $4,466.84 / $9,120.11
| Facility | | $4,466.84 | $4,466.84 | $9,120.11 |