- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,648.45 / $2,648.45 / $19,174.59
| Facility | | $2,648.45 | $2,648.45 | $19,174.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $591.46 / $658.61 / $717.55
| Facility | | $591.46 | $658.61 | $717.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $633.79 / $633.79 / $633.79
| Facility | | $633.79 | $633.79 | $633.79 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $63.12 / $63.12 / $63.12
| Facility | AS | $63.12 | $63.12 | $63.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,809.26 / $3,433.23 / $30,491.97
| Facility | | $2,809.26 | $3,433.23 | $30,491.97 |