- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $213.80 / $213.80 / $213.80
| Facility | | $213.80 | $213.80 | $213.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $10,715.19 / $26,302.68
| Facility | | $575.44 | $10,715.19 | $26,302.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $512.86 / $812.83 / $1,949.84
| Facility | | $512.86 | $812.83 | $1,949.84 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $323.59 / $323.59 / $323.59
| Facility | 52 | $323.59 | $323.59 | $323.59 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $40.74 / $40.74 / $40.74
| Facility | AS | $40.74 | $40.74 | $40.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $776.25 / $1,513.56
| Facility | | $630.96 | $776.25 | $1,513.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $229.09 / $354.81 / $794.33
| Facility | | $229.09 | $354.81 | $794.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $794.33 / $3,311.31 / $8,511.38
| Facility | | $794.33 | $3,311.31 | $8,511.38 |