- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $7,838.38 / $7,838.38
| Facility | | $1,000.00 | $7,838.38 | $7,838.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,307.42 / $1,307.42 / $1,307.42
| Facility | | $1,307.42 | $1,307.42 | $1,307.42 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $128.13 / $128.13 / $128.13
| Facility | AS | $128.13 | $128.13 | $128.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,088.57 / $1,307.42 / $1,731.75
| Facility | | $1,088.57 | $1,307.42 | $1,731.75 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $128.13 / $128.13 / $128.13
| Facility | AS | $128.13 | $128.13 | $128.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,085.00 / $4,616.00 / $15,732.00
| Facility | | $3,085.00 | $4,616.00 | $15,732.00 |