- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $348.95 / $534.54 / $4,792.32
| Facility | | $348.95 | $534.54 | $4,792.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $366.63 / $413.96 / $451.02
| Facility | | $366.63 | $413.96 | $451.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $392.46 / $392.46 / $392.46
| Facility | | $392.46 | $392.46 | $392.46 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $38.74 / $38.74 / $38.74
| Facility | AS | $38.74 | $38.74 | $38.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,943.52 / $10,239.46 / $36,836.23
| Facility | | $5,943.52 | $10,239.46 | $36,836.23 |