- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $977.24 / $3,715.35 / $12,882.50
| Facility | | $977.24 | $3,715.35 | $12,882.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.88 / $12.88 / $12.88
| Facility | | $12.88 | $12.88 | $12.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $54.95 / $56.23 / $1,288.25
| Facility | | $54.95 | $56.23 | $1,288.25 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $9.77 / $9.77 / $9.77
| Facility | AS | $9.77 | $9.77 | $9.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16.98 / $33.11 / $5,128.61
| Facility | | $16.98 | $33.11 | $5,128.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15.85 / $21.38 / $38.02
| Facility | | $15.85 | $21.38 | $38.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $154.88 / $1,047.13 / $2,691.53
| Facility | | $154.88 | $1,047.13 | $2,691.53 |