- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $697.92 / $1,151.33 / $3,770.34
| Facility | | $697.92 | $1,151.33 | $3,770.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $803.69 / $891.62 / $971.45
| Facility | | $803.69 | $891.62 | $971.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $860.78 / $860.78 / $860.78
| Facility | | $860.78 | $860.78 | $860.78 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $85.67 / $85.67 / $85.67
| Facility | AS | $85.67 | $85.67 | $85.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,987.77 / $7,987.77 / $7,987.77
| Facility | | $7,987.77 | $7,987.77 | $7,987.77 |