- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $346.74 / $2,290.87 / $4,786.30
| Facility | | $346.74 | $2,290.87 | $4,786.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $363.08 / $363.08 / $446.68
| Facility | | $363.08 | $363.08 | $446.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $588.84 / $588.84 / $588.84
| Facility | | $588.84 | $588.84 | $588.84 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $58.88 / $58.88 / $58.88
| Facility | AS | $58.88 | $58.88 | $58.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,943.28 / $9,549.93 / $37,153.52
| Facility | | $7,943.28 | $9,549.93 | $37,153.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,548.13 / $3,548.13 / $16,982.44
| Facility | | $3,548.13 | $3,548.13 | $16,982.44 |